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Perioperative renal protection

Ozgur Haki Yuksel, Caglar Yildirim, Ahmet Urkmez, Nurver Ozbay, Fatih Uruc, Aytac Sahin, Serkan Akan, Ayhan Verit
OBJECTIVES: The most important treatment strategy for obstructive nephropathy is to protect renal tissue from the deleterious effects of fibrosis. Therefore, we sought to investigate the renoprotective effects of darbepoetin alfa on unilateral ureteral obstructions. METHODS: We used 12 female and 12 male 3-monthold Wistar rats weighing between 250 and 350 g. The rats were divided equally into sham, darbepoetin and control groups. With the exception of the sham group, left unilateral obstructions were applied to all of the rats...
March 2018: Archivos Españoles de Urología
Sheriff D Akinleye, Garret Garofolo, Maya Deza Culbertson, Peter Homel, Orry Erez
Introduction: Obesity is an oft-cited cause of surgical morbidity and many institutions require extensive supplementary screening for obese patients prior to surgical intervention. However, in the elderly patients, obesity has been described as a protective factor. This article set out to examine the effect of body mass index (BMI) on outcomes and morbidity after hip fracture surgery. Methods: The National Surgical Quality Improvement Program database was queried for all patients undergoing 1 of 4 surgical procedures to manage hip fracture between 2008 and 2012...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
Yuichiro Kishimoto, Yoshinobu Nakamura, Shingo Harada, Takeshi Onohara, Satoru Kishimoto, Tomohiro Kurashiki, Yoshikazu Fujiwara, Motonobu Nishimura
BACKGROUND: Oral administration of tolvaptan, a vasopressin V2 receptor antagonist, significantly reduces deterioration of renal function, which has recently been highlighted as an exacerbating factor for adverse events in patients with acute heart failure. In the present study we tested the hypothesis that concomitant administration of tolvaptan with a conventional diuretic is beneficial for perioperative body fluid management in patients who have undergone cardiac surgery.Methods and Results:In all, 280 patients who underwent cardiac surgery were prospectively randomized to concomitant treatment with tolvaptan and a conventional diuretic (tolvaptan group; 147 patients) or treatment with a conventional diuretic alone (control group; 133 patients)...
February 21, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Alexander Light, Sandeep Karthikeyan, Sachan Maruthan, Oussama ElHage, Hansjörg Danuser, Prokar Dasgupta
OBJECTIVE: To analyse the current difference between dismembered robotic-assisted pyeloplasty (RP) and laparoscopic pyeloplasty (LP) in the treatment of pelvi-ureteric junction obstruction (PUJO) patients as of June 26 2017, focusing on operative time, length of hospital stay, complication rate, and success rate. PATIENTS AND METHODS: We searched PubMed, Medline, and Embase databases, consulted experts, reviewed reference lists, used the related articles PubMed feature, and reviewed scientific meeting abstracts for eligible articles from 1993 to June 26 2017...
February 17, 2018: BJU International
Scott C Johnson, Zachary L Smith, Shay Golan, Joseph F Rodriguez, Shane M Pearce, Norm D Smith, Gary D Steinberg
PURPOSE: Patients on hemodialysis have an increased risk of developing advanced stage bladder cancer. They also have a significant risk of noncancer-related mortality. Radical cystectomy (RC) is the standard of care for nonmetastatic muscle-invasive bladder cancer, however little is known regarding outcomes in this population. MATERIALS AND METHODS: The United States Renal Disease System database was used to identify all patients on hemodialysis who underwent RC for bladder cancer in the United States between 1984 and 2013...
January 21, 2018: Urologic Oncology
Endre Nemeth, Eniko Kovacs, Kristof Racz, Adam Soltesz, Szabolcs Szigeti, Nikolett Kiss, Gergely Csikos, Kinga B Koritsanszky, Viktor Berzsenyi, Gabor Trembickij, Szabolcs Fabry, Zoltan Prohaszka, Bela Merkely, Janos Gal
AIM: The aim of this study was to assess the influence of intraoperative cytokine adsorption on the perioperative vasoplegia, inflammatory response and outcome during orthotopic heart transplantation (OHT). METHODS: 84 OHT patients were separated into the cytokine adsorption (CA) treated group or controls. Vasopressor demand, inflammatory response described by procalcitonin and C-reactive protein and postoperative outcome were assessed performing propensity score matching...
January 29, 2018: Clinical Transplantation
Joan C Delto, David Paulucci, Michael W Helbig, Ketan K Badani, Daniel Eun, James Porter, Ronney Abaza, Ashok K Hemal, Akshay Bhandari
OBJECTIVES: To compare peri-operative outcomes after robot-assisted partial nephrectomy (RAPN) for cT2a (7 to <10 cm) to cT1 tumours. MATERIALS AND METHODS: Patients with a cT1a (n = 1 358, 76.4%), cT1b (n = 379, 21.3%) or cT2a (n = 41, 2.3%) renal mass were identified from a multi-institutional RAPN database. Intra- and postoperative outcomes were compared for cT2a masses vs cT1a and cT1b masses using multivariable regression models (linear, logistic, Poisson etc...
January 22, 2018: BJU International
Rajinder Singh Rawat, Said Musallam Al Maashani
No abstract text is available yet for this article.
January 2018: Annals of Cardiac Anaesthesia
C Williams, K Borges, T Banh, J Vasilevska-Ristovska, R Chanchlani, V L Ng, A I Dipchand, M Solomon, D Hebert, S J Kim, B C Astor, R S Parekh
The incidence of acute kidney injury (AKI) and its impact on chronic kidney disease (CKD) following pediatric non-kidney solid organ transplantation is unknown. We aimed to determine the incidence of AKI and CKD and examine their relationship among children who received a heart, lung, liver or multi-organ transplant at the Hospital for Sick Children between 2002 and 2011. AKI was assessed in the first year post-transplant. Among 303 children, perioperative AKI (within the first week) occurred in 67% of children, and AKI after the first week occurred in 36%, with the highest incidence among lung and multi-organ recipients...
December 29, 2017: American Journal of Transplantation
Leilei Xia, Jose E Pulido, Raju R Chelluri, Marshall C Strother, Benjamin L Taylor, Jay D Raman, Thomas J Guzzo
OBJECTIVE: To evaluate the impact of hospital volume on outcomes of robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS: Patients with renal cell carcinoma who underwent RAPN between 2010 and 2013 were identified in the National Cancer Database. Hospital yearly RAPN volume was categorized into groups by sorting patients as closely as possible into five groups of equal size (quintiles): very low; low; medium; high; and very high volume. Outcomes included 30-day mortality, 90-day mortality, open conversion, prolonged length of hospital stay (PLOS; defined as >3 days), 30-day readmission rate, and positive surgical margin (PSM) rate...
December 12, 2017: BJU International
Yushu Wang, Sui Zhu, Rongsheng Du, Juteng Zhou, Yucheng Chen, Qing Zhang
BACKGROUND: The effects of preoperative statin therapy (PST) on renal outcomes in patients with isolated coronary artery bypass grafting (CABG) are in controversial. This study aimed to assess the effects of preoperative statin use on postoperative renal outcomes in patients undergoing isolated CABG. METHODS: PubMed, EMBASE, and Cochrane Library were searched for studies published up to February 2017. Pooled odds ratio (OR) and its corresponding 95% confidence interval (95% CI) were calculated...
November 16, 2017: Journal of Cardiovascular Surgery
Lian Duan, Guo-Huang Hu, Meng Jiang, Cheng-Liang Zhang
OBJECTIVE: To analyze the perioperative clinical data of children with congenital heart disease complicated by acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery, and to explore potential factors influencing the prognosis. METHODS: A retrospective analysis was performed among 118 children with congenital heart disease who developed AKI within 48 hours after CPB surgery. RESULTS: In the 118 patients, 18 died after 48 hours of surgery...
November 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Negar Motayagheni, Sheshanna Phan, Crystal Eshraghi, Ala Nozari, Anthony Atala
BACKGROUND: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence...
2017: American Journal of Nephrology
Xiangming Wang, Na Kong, Chuanwei Zhou, Deeraj Mungun, Zakaria Iyan, Yan Guo, Zhijian Yang
BACKGROUND: The main objective of this meta-analysis was to investigate whether remote ischemic preconditioning (RIPC) reduces cardiac and renal events in patients undergoing elective cardiovascular interventions. METHODS AND RESULTS: We systematically searched articles published from 2006 to 2016 in PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables...
2017: Cardiology Research and Practice
K Wentlandt, A Weiss, E O'Connor, E Kaya
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy...
December 2017: American Journal of Transplantation
Vladimir Cerny, David Astapenko, Florian Brettner, Jan Benes, Radomir Hyspler, Christian Lehmann, Zdenek Zadak
The purpose of this manuscript is to review the role of endothelial glycocalyx (EG) in the field of critical and perioperative medicine and to discuss possible future directions for investigations in this area. Under physiological conditions, EG has several well-defined functions aimed to prevent the disruption of vessel wall integrity. Under pathological conditions, the EG represent one of the earliest sites of injury during inflammation. EG structure and function distortion contribute to organ dysfunction related to sepsis, trauma, or global ischemia of any origin...
August 2017: Critical Reviews in Clinical Laboratory Sciences
Y Kim, A D Jung, V K Dhar, J S Tadros, D P Schauer, E P Smith, D J Hanseman, M C Cuffy, R R Alloway, A R Shields, S A Shah, E S Woodle, T S Diwan
Morbid obesity is a barrier to kidney transplantation due to inferior outcomes, including higher rates of new-onset diabetes after transplantation (NODAT), delayed graft function (DGF), and graft failure. Laparoscopic sleeve gastrectomy (LSG) increases transplant eligibility by reducing BMI in kidney transplant candidates, but the effect of surgical weight loss on posttransplantation outcomes is unknown. Reviewing single-center medical records, we identified all patients who underwent LSG before kidney transplantation from 2011-2016 (n = 20)...
August 14, 2017: American Journal of Transplantation
Sohrab Arora, Ronney Abaza, James M Adshead, Rajesh K Ahlawat, Benjamin J Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A Moon, Thyavihally B Yuvaraja, Umberto Capitanio, Alessandro Larcher, Francesco Porpiglia, James R Porter, Alexander Mottrie, Mahendra Bhandari, Craig Rogers
OBJECTIVES: To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. PATIENTS AND METHODS: In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients...
January 2018: BJU International
Sri Harsha Tella, Hayet Amalou, Bradford J Wood, Richard Chang, Clara C Chen, Cemre Robinson, Michelle Millwood, Lori C Guthrie, Sheng Xu, Elliot Levy, Venkatesh Krishnasamy, Rachel I Gafni, Michael T Collins
Tumor-induced osteomalacia (TIO) is a debilitating paraneoplastic condition caused by small phosphaturic mesenchymal tumors (PMTs) that secrete large amounts of the phosphate-regulating and vitamin D-regulating hormone, FGF23. Tumor removal results in cure. However, because of high perioperative comorbidity, either from tumor location or host factors, surgery is sometimes not an option. Tumor destruction via cryoablation may be an effective option for inoperable PMTs. Three subjects with a confirmed diagnosis of TIO were studied...
November 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Caitlin W Hicks, Anna O'Kelly, Tammam Obeid, Satinderjit Locham, Mahmoud B Malas
BACKGROUND: We aim to describe trends in failure to rescue (FTR) among elderly patients undergoing elective open aortic aneurysm repair (OAR) and endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: All patients aged ≥80 y recorded in the Vascular Quality Initiative database (2002-2014) undergoing nonruptured infrarenal AAA repair were included. Primary outcome was FTR, defined as percentage of deaths in patients who had a complication within 30 d of surgery...
September 2017: Journal of Surgical Research
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