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What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?

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机构： [a]Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China [b]State Key Laboratory of Oncology in Southern China, Guangzhou, China [c]Collaborative Innovation Center for Cancer Medicine, Guangzhou, China [d]Department of Anatomic Pathology, Robert J. Tomsich Pathology and LaboratoryMedicine Institute, Cleveland Clinic, Cleveland, OH, USA [e]State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease,Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China [f]Department of Urology, Glickman Urological and Kidney Institute,Cleveland Clinic, Cleveland, OH, USA [g]Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China [h]Department of Urology, FirstAffiliated Hospital of Zhengzhou University, Henan, China [i]Department of Urology, Peking University First Hospital, Beijing, China [j]Department of Urology,West China Hospital of Sichuan University, Sichuan, China [k]Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, Shanghai,China [l]Department of Urology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China [m]Department of Urology, Yantai Yuhuangding Hospital,Shandong, China [n]Department of Urology, Xiangya Hospital of Central South University, Changsha, China [o]Department of Urology, The First People’s Hospitalof Chenzhou, Hunan, China [p]Department of Pathology, Hainan General Hospital, Hainan, China [q]Department of Urology, The First Affiliated Hospital ofGuangzhou Medical University, Guangzhou, China [r]Department of Urology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University ofScience and Technology, Shenzhen, China [s]Department of Urology, The Second Clinical College of Jinan University, Shenzhen, China [t]Department of Urology,Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China [u]Department of Urology, Ruijin Hospital of Shanghai Jiaotong University School ofMedicine, Shanghai, China [v]Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China [w]Department of Oncology, Shanghai MedicalCollege, Fudan University, Shanghai, China [x]Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China [y]Department ofUrology, The Third Xiangya Hospital of Central South University, Hunan, China [z]Department of Urology, No. 1 Hospital of Lian Yungang, Jiangsu, China

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Most partial nephrectomies (PNs) are performed with hilar occlusion to reduce blood loss and optimize visualization. However, the histologic status of the preserved renal parenchyma years after PN is unknown.To compare the histologic chronic kidney disease (CKD) score of renal parenchyma before and years after PN, and to explore factors associated with CKD-score increase and glomerular filtration rate (GFR) decline.A retrospective review of 147 renal cell carcinoma patients who underwent PN and subsequent radical nephrectomy (RN) due to tumor recurrence was performed in 19 Chinese centers and Cleveland Clinic. Macroscopic normal renal parenchyma was evaluated at least 5 mm away from the tumor in PN specimens and at remote sites in RN specimens.PN/RN and ischemia.Histologic CKD score (0-12) represents a summary of glomerular/tubular/interstitial/vascular status. Predictive factors for a substantial increase of CKD score (≥3) were evaluated by logistic regression.Sixty-five patients with all necessary data were analyzed. The median interval between PN and RN was 2.4 yr. Median durations of warm ischemia (n = 42) and hypothermia (n = 23) were both 23 min. The histologic CKD score was increased after RN in 47 (72%) patients, with 29 (45%) experiencing more substantial increase (≥3). There was no significant difference in the change of CKD score related to the type and duration of ischemia (p = 0.7 and p = 0.4, respectively) or interval from PN to RN (p > 0.9). However, patients with comorbidities of hypertension, diabetes, and/or pre-existing CKD (hypertension [HTN]/diabetes mellitus [DM]/CKD) demonstrated increased rate and extent of CKD-score increase. On univariate analysis, HTN/DM/CKD was the only predictor of a substantial CKD-score increase (odds ratio: 3.53 [1.12-11.1]). Decline of GFR was modest and similar between patients with/without a substantial CKD-score increase.Within the context of conventional, limited durations of ischemia, histologic deterioration of preserved parenchyma after PN appears to be primarily due to pre-existing medical comorbidities rather than ischemia. A subsequent decline in renal function was mild and independent of histologic changes.After clamped PN, the preserved renal parenchyma demonstrated histologic deterioration in many cases, which correlated with the presence of comorbidities such as hypertension, diabetes mellitus, or chronic kidney disease. In contrast, the type and duration of ischemia did not correlate with histologic changes after PN, suggesting that ischemia insult had only limited impact on parenchyma deterioration.Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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出版当年[2022]版：

大类 | 1 区

医学

小类 | 1 区泌尿学与肾脏学

最新[2023]版：

大类 | 1 区

医学

小类 | 1 区泌尿学与肾脏学

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出版当年[2022]版：

Q1 UROLOGY & NEPHROLOGY

最新[2023]版：

Q1 UROLOGY & NEPHROLOGY

影响因子： 25.3 最新[2023版] 19.4 最新五年平均 23.4 出版当年[2022版] 19.9 出版当年五年平均 24.344 出版前一年[2021版] 25.3 出版后一年[2023版]

第一作者：

第一作者机构： [a]Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China [b]State Key Laboratory of Oncology in Southern China, Guangzhou, China [c]Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

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通讯作者：

通讯机构： [a]Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China [b]State Key Laboratory of Oncology in Southern China, Guangzhou, China [c]Collaborative Innovation Center for Cancer Medicine, Guangzhou, China [f]Department of Urology, Glickman Urological and Kidney Institute,Cleveland Clinic, Cleveland, OH, USA [*1]Sun Yat-Sen University Cancer Center, Dongfengdonglu 651, Guangzhou, China. [*2]Center for Urologic Oncology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA [*3]Department of Urology, Sun Yat-Sen University Cancer Center, Dongfengdonglu 651, Guangzhou, China.

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