Minimal arterial in-flow protects renal oxygenation and function during porcine partial nephrectomy: Confirmation by hyperspectral imaging

Sara L. Best, Abhas Thapa, Michael J. Holzer, Neil Jackson, Saad A. Mir, Jeffrey A Cadeddu, Karel J. Zuzak

Research output: Contribution to journalArticle

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Abstract

Objectives: To examine the potential for renal protection through incomplete renal artery (RA) occlusion with both assessments of creatinine changes and the use of hyperspectral imaging to monitor tissue oxygenation. Renal ischemia during partial nephrectomy can have adverse consequences on renal function. Methods: Fourteen pigs with a solitary kidney underwent open partial nephrectomy with warm ischemia. The RA flow was measured and reduced to 25%, 10%, and 0% of baseline for 60 minutes. Hyperspectral imaging was used to assess the percentage of oxyhemoglobin (%HbO 2) at baseline, during ischemia, and during reperfusion. The %HbO 2 and change in the serum creatinine level from baseline were compared. Results: The baseline RA flow and %HbO 2 were similar in all groups, and, as expected, RA occlusion resulted in decreasing %HbO 2. The reduction of RA flow to 25% and 10% improved the nadir tissue oxygenation compared with 0% flow (P =.01 and P =.04, respectively) and 25% flow also appeared to prolong the interval to reach the nadir %HbO 2. Reperfusion resulted in a swift return to the baseline %HbO 2 in all 3 groups. The change in the serum creatinine from baseline to postoperative day 7 showed significantly improved renal preservation in the 25% RA flow group. Conclusions: Incomplete RA occlusion during porcine partial nephrectomy resulted in favorable renal oxygenation profiles with as little as 10% blood flow and appeared to be renoprotective when 25% of the baseline RA flow is preserved. Hyperspectral imaging is a sensitive, noninvasive tool for real-time monitoring of renal oxygenation and, thereby, blood flow, which could facilitate intraoperative decision-making to protect kidney function.

Original languageEnglish (US)
Pages (from-to)961-966
Number of pages6
JournalUrology
Volume78
Issue number4
DOIs
StatePublished - Oct 2011

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Renal Artery
Nephrectomy
Swine
Kidney
Creatinine
Reperfusion
Ischemia
Warm Ischemia
Oxyhemoglobins
Serum
Decision Making

ASJC Scopus subject areas

  • Urology

Cite this

Minimal arterial in-flow protects renal oxygenation and function during porcine partial nephrectomy : Confirmation by hyperspectral imaging. / Best, Sara L.; Thapa, Abhas; Holzer, Michael J.; Jackson, Neil; Mir, Saad A.; Cadeddu, Jeffrey A; Zuzak, Karel J.

In: Urology, Vol. 78, No. 4, 10.2011, p. 961-966.

Research output: Contribution to journalArticle

Best, Sara L. ; Thapa, Abhas ; Holzer, Michael J. ; Jackson, Neil ; Mir, Saad A. ; Cadeddu, Jeffrey A ; Zuzak, Karel J. / Minimal arterial in-flow protects renal oxygenation and function during porcine partial nephrectomy : Confirmation by hyperspectral imaging. In: Urology. 2011 ; Vol. 78, No. 4. pp. 961-966.
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abstract = "Objectives: To examine the potential for renal protection through incomplete renal artery (RA) occlusion with both assessments of creatinine changes and the use of hyperspectral imaging to monitor tissue oxygenation. Renal ischemia during partial nephrectomy can have adverse consequences on renal function. Methods: Fourteen pigs with a solitary kidney underwent open partial nephrectomy with warm ischemia. The RA flow was measured and reduced to 25{\%}, 10{\%}, and 0{\%} of baseline for 60 minutes. Hyperspectral imaging was used to assess the percentage of oxyhemoglobin ({\%}HbO 2) at baseline, during ischemia, and during reperfusion. The {\%}HbO 2 and change in the serum creatinine level from baseline were compared. Results: The baseline RA flow and {\%}HbO 2 were similar in all groups, and, as expected, RA occlusion resulted in decreasing {\%}HbO 2. The reduction of RA flow to 25{\%} and 10{\%} improved the nadir tissue oxygenation compared with 0{\%} flow (P =.01 and P =.04, respectively) and 25{\%} flow also appeared to prolong the interval to reach the nadir {\%}HbO 2. Reperfusion resulted in a swift return to the baseline {\%}HbO 2 in all 3 groups. The change in the serum creatinine from baseline to postoperative day 7 showed significantly improved renal preservation in the 25{\%} RA flow group. Conclusions: Incomplete RA occlusion during porcine partial nephrectomy resulted in favorable renal oxygenation profiles with as little as 10{\%} blood flow and appeared to be renoprotective when 25{\%} of the baseline RA flow is preserved. Hyperspectral imaging is a sensitive, noninvasive tool for real-time monitoring of renal oxygenation and, thereby, blood flow, which could facilitate intraoperative decision-making to protect kidney function.",
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T2 - Confirmation by hyperspectral imaging

AU - Best, Sara L.

AU - Thapa, Abhas

AU - Holzer, Michael J.

AU - Jackson, Neil

AU - Mir, Saad A.

AU - Cadeddu, Jeffrey A

AU - Zuzak, Karel J.

PY - 2011/10

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N2 - Objectives: To examine the potential for renal protection through incomplete renal artery (RA) occlusion with both assessments of creatinine changes and the use of hyperspectral imaging to monitor tissue oxygenation. Renal ischemia during partial nephrectomy can have adverse consequences on renal function. Methods: Fourteen pigs with a solitary kidney underwent open partial nephrectomy with warm ischemia. The RA flow was measured and reduced to 25%, 10%, and 0% of baseline for 60 minutes. Hyperspectral imaging was used to assess the percentage of oxyhemoglobin (%HbO 2) at baseline, during ischemia, and during reperfusion. The %HbO 2 and change in the serum creatinine level from baseline were compared. Results: The baseline RA flow and %HbO 2 were similar in all groups, and, as expected, RA occlusion resulted in decreasing %HbO 2. The reduction of RA flow to 25% and 10% improved the nadir tissue oxygenation compared with 0% flow (P =.01 and P =.04, respectively) and 25% flow also appeared to prolong the interval to reach the nadir %HbO 2. Reperfusion resulted in a swift return to the baseline %HbO 2 in all 3 groups. The change in the serum creatinine from baseline to postoperative day 7 showed significantly improved renal preservation in the 25% RA flow group. Conclusions: Incomplete RA occlusion during porcine partial nephrectomy resulted in favorable renal oxygenation profiles with as little as 10% blood flow and appeared to be renoprotective when 25% of the baseline RA flow is preserved. Hyperspectral imaging is a sensitive, noninvasive tool for real-time monitoring of renal oxygenation and, thereby, blood flow, which could facilitate intraoperative decision-making to protect kidney function.

AB - Objectives: To examine the potential for renal protection through incomplete renal artery (RA) occlusion with both assessments of creatinine changes and the use of hyperspectral imaging to monitor tissue oxygenation. Renal ischemia during partial nephrectomy can have adverse consequences on renal function. Methods: Fourteen pigs with a solitary kidney underwent open partial nephrectomy with warm ischemia. The RA flow was measured and reduced to 25%, 10%, and 0% of baseline for 60 minutes. Hyperspectral imaging was used to assess the percentage of oxyhemoglobin (%HbO 2) at baseline, during ischemia, and during reperfusion. The %HbO 2 and change in the serum creatinine level from baseline were compared. Results: The baseline RA flow and %HbO 2 were similar in all groups, and, as expected, RA occlusion resulted in decreasing %HbO 2. The reduction of RA flow to 25% and 10% improved the nadir tissue oxygenation compared with 0% flow (P =.01 and P =.04, respectively) and 25% flow also appeared to prolong the interval to reach the nadir %HbO 2. Reperfusion resulted in a swift return to the baseline %HbO 2 in all 3 groups. The change in the serum creatinine from baseline to postoperative day 7 showed significantly improved renal preservation in the 25% RA flow group. Conclusions: Incomplete RA occlusion during porcine partial nephrectomy resulted in favorable renal oxygenation profiles with as little as 10% blood flow and appeared to be renoprotective when 25% of the baseline RA flow is preserved. Hyperspectral imaging is a sensitive, noninvasive tool for real-time monitoring of renal oxygenation and, thereby, blood flow, which could facilitate intraoperative decision-making to protect kidney function.

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