Effect of Warm Ischemia on Renal Function During Partial Nephrectomy: Assessment With New ^99mTc-Mercaptoacetyltriglycine Scintigraphy Parameter

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• 作者：Yasuhito Funahashi ; ^{funa418@yahoo.co.jp} ; Ryohei Hattori ; Tokunori Yamamoto ; Naoto Sassa ; Takashi Fujita ; Momokazu Gotoh
• 刊名：Urology
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：79
• 期：1
• 页码：160-164
• 全文大小：293 K

文摘

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Objective

A decrease in renal function after partial nephrectomy caused by ischemic damage or nephron loss cannot be distinguished by conventional methods. We quantified renal function using a new ^99mTc-mercaptoacetyltriglycine (^99mTc-MAG3) renal scintigraphy parameter.

Material and Methods

We included 32 patients with a normally functioning contralateral kidney who received open partial nephrectomy with average warm ischemic time of 26.0 (range 14-46) min in this study. Effective renal plasma flow (ERPF) was calculated from ^99mTc-MAG3 renal scintigraphy before and at 1 week and 6 months after surgery. We also analyzed regional ^99mTc-MAG3 uptake in the surgically nonaffected parts.

Results

One week after surgery, average ERPF in the operated kidney decreased to 66.4 % from baseline (from 177.8 to 116.9 mL/min/1.73 m²) and regional ^99mTc-MAG3 uptake decreased to 83.4 % . A stronger correlation was found between ischemic time and the decrease in regional ^99mTc-MAG3 uptake (P < .001) compared with ERPF (P = .029). The decrease in regional ^99mTc-MAG3 uptake remained at 6 months in the group with ischemic time ?5 minutes, whereas it recovered when ischemic time was <25 minutes.

Conclusion

This new parameter quantified ischemic renal damage better than the conventional split functional evaluation. When warm ischemic time was ?5 minutes, irreversible diffuse damage was seen in surgically preserved nephrons.