Hemodynamics and functional state of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer

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Abstract

AIM: To study the hemodynamics and functional state of the renal tissue of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer.

MATERIALS AND METHODS: The prospective study included 58 patients with renal cell carcinoma, 36 (62.1%) of whom underwent radical nephrectomy, and 22 (37.9%) underwent partial nephrectomy. Tumor sizes ranged from 1.0 to 12.0 cm. All patients before surgery and in the early postoperative period underwent ultrasound examination of the structure and size of the kidneys, Doppler ultrasonography of the renal vessels, biomicroscopy of the bulbar conjunctiva, measured peripheral blood pressure, determined the glomerular filtration rate (GFR) and performed a coagulogram. The control group included 16 healthy adults.

RESULTS: In 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy a tendency towards an increase in blood pressure compared with the initial values was noted by the 2-4th day after the operation. By the 5th day after surgery, the volume of the only kidney remaining after radical nephrectomy increased by an average of 4% (from 126.1 ± 1.4 to 131.2 ± 2.1 cm3, p < 0.05), while after partial nephrectomy has not changed reliably. After surgery, a decrease in GFR was detected in 34 (58.6%; p < 0.05) patients, including after radical nephrectomy (n = 28) – up to 73.4 ± 8.2 ml / min / 1.73 m2, after partial nephrectomy (n = 6) – up to 98.2 ± 3.4 ml / min / 1.73 m2. Doppler ultrasonography of the vessels of a single kidney in patients after radical nephrectomy showed a moderate increase in linear blood flow, an increase in the resistance index in the main trunk of the renal artery, and a decrease in the pulsation index in the segmental and arc arteries. In patients after partial nephrectomy in the contralateral kidney these changes were not observed. When performing biomicroscopy of the bulbar conjunctiva in 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy, changes in the microvasculature were revealed: narrowing of arterioles, expansion of venules, slowing of venular and capillary blood flow. Before the operation and in the early postoperative period, the content of fibrinogen and soluble fibrin-monomer complex in the blood of patients with renal cell carcinoma was significantly higher than in the control group.

CONCLUSIONS: In patients with renal cell carcinoma, changes in the contralateral kidney in the early postoperative period after radical nephrectomy are significantly more pronounced than after partial nephrectomy, and are accompanied by changes in systemic and local hemodynamics and kidney function. The results of the study confirm the feasibility of performing organ-preserving surgeries in patients with renal cell carcinoma.

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About the authors

Igor I. Tityaev

City Clinical Hospital No. 1

Email: kasyanovds@mail.ru
ORCID iD: 0000-0003-3384-7147

Dr. Sci. (Med.), Professor, Urologist

Russian Federation, 6 Zalesskogo str., Novosibirsk, 630047

Igor V. Tikhonov

City Clinical Hospital No. 3

Email: tihonoff2701@yandex.ru

Dr. Sci. (Med.), Urologist

Russian Federation, Barnaul

Boris A. Neymark

Altai State Medical University; Clinical Hospital Russian Railways-Medicine of the city of Barnaul

Email: neimark.b@mail.ru
ORCID iD: 0000-0001-8009-3777
SPIN-code: 7886-8442
Scopus Author ID: 6602800153

Doc. Sci. (Med.), Professor, Head of the Urological Division

Russian Federation, Barnaul; Barnaul

Sergey S. Andreev

City Clinical Hospital No. 1

Email: andreev723@yandex.ru

Head of the Urological Division

Russian Federation, 6 Zalesskogo str., Novosibirsk, 630047

Svetlana V. Andreeva

City Clinical Hospital No. 1

Email: andreev723@yandex.ru

Head of the Department of Ultrasound Diagnostics

Russian Federation, 6 Zalesskogo str., Novosibirsk, 630047

Konstantin V. Udalov

City Clinical Hospital No. 1; Novosibirsk State Medical University

Email: k.udalov@mail.ru
SPIN-code: 4034-2404

Head of the Oncourology Division

Russian Federation, 6 Zalesskogo str., Novosibirsk, 630047; Novosibirsk

Denis S. Kasyanov

City Clinical Hospital No. 1

Author for correspondence.
Email: kasyanovds@mail.ru

Urologist, Оncologist

Russian Federation, 6 Zalesskogo str., Novosibirsk, 630047

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