Nephrectomy

Levine and coworkers first reported on the real-time profiling of kidney tubular fluid nitric oxide concentration in vivo [89, 91], In the 2001 publication, a modified version of a combination NO electrode (WPI, ISONOP007) was successfully used to measure NO concentration profiles along the length of a single nephron of a rat kidney tubular segment. Since it was shown that the electrode is sensitive to NO in the rat tubule it was used to detect NO concentration differences in rat kidney tubules before and after 5/6 nephrectomy. The results clearly showed that the NO concentration was much higher in nephrectomized rats vs unnephrectomized rats. 

Urologic procedures requiring an abdominal approach such as a nephrectomy or cystectomy require prophylaxis appropriate for a clean-contaminated abdominal procedure. 

I FH, <2 yr old, tumor <550 g Nephrectomy only Followed q 3 mo with CXR and abdominal ultrasound... 

Hypertension is both a cause and a result of CRF. Most dialysis patients are salt and water sensitive. Thus, if one removes salt and water with the dialysis procedure and minimizes weight gain between dialysis with strict dietary control of salt and water intake, normal blood pressure can be achieved. The availability of newer and effective antihypertensive agents has largely replaced the use of bilateral nephrectomy to control the blood pressure. 

Surgery remains the mainstay of treatment for localized disease. Approximately 30% of patients present with metastatic disease. Although nephrectomy has traditionally not been recommended in the context of metastatic disease, except in cases of pain or hemorrhage due to local tumor burden, two recent phase III studies have reported modest improvement in durations of survival when carefully selected patients undergo nephrectomy followed by interferon therapy. The larger of the two studies reported a median survival advantage of 3 months. 

Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V McGrath PC et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001 345 1655-9. 

Therapy in those with ectopic erythropoietin production depends upon correcting the hormone level by removing whatever tissue is responsible for its production and examples include nephrectomy for renal carcinoma or the classical, albeit rare, cerebellar haemangioblastoma. Where metastases have occurred appropriate cytotoxic chemotherapy is needed and response in haematocrit becomes a rough indicator of the success with which the tumour is responding to therapy. In some individuals venesections are necessary to control the raised haemoglobin. 

Maintenance of red cell volume is critical to having an adequate oxygen supply to the tissues [10]. Healthy individuals finely balance erythropoiesis and erythrocyte loss and maintain constant hematocrit. The glycoprotein hormone erythropoietin is the principal controller of the homeostatic mechanism that links tissue oxygen delivery to red cell production. While hypothesized as early as 1863, unequivocal evidence of erythropoietin was first published in 1953. A few years later, scientists showed that animals subjected to bilateral nephrectomy were unable to mount an erythropoietin response to hypoxia. Indeed, the kidneys produce about 90% of circulating erythropoietin. 

Pruthi RS, Kang J, Vick R. Desmopressin induced hyponatremia and seizures after laparoscopic radical nephrectomy. J Urol 2002 168(1) 187. 

Neurogenic renal vasoconstriction, with consequent activation of the renin-angio-tonin mechanism, is not a major factor in most cases of neurogenic hypertension evidence for this is seen in the limited fall in blood pressure which follows renal denervation (41, 54) and the failure of prior nephrectomy to alter the pressor response to moderator nerve section (95). However, neurogenic renal vasoconstriction may be adequate to produce a sustained hypertension after other body structures have been sympathetically denervated (42, 44)) and it is possible that neurogenic renal vasoconstriction may play a significant role in the development of essential hypertension. 

Congenital nephrotic syndrome of the Finnish type is clinically characterized by heavy proteinuria present already in utero, which leads without nephrectomy and renal replacement therapy to the death of the affected children usually before the second year of life. Electronoptically, the glomerular basement membrane seems to be intact with the fusion of the podocyte foot processes. The chemical composition of the glomerular basement membrane is normal in patients with congenital nephrotic syndrome and all genes of the main proteins of the glomerular... 

In animal models of acute renal failure induced in rats by bilateral nephrectomy and bilateral ureteral ligation, TAC increased, probably due to the accumulation of urate and uremic toxins with scavenging capacity, such as hyppurate (B19, S9). TAC of blood plasma was reduced in a rat endotoxic shock model (rats given i.p. 5 mg/kg lipopolysaccharide) (Cl6). 

Thurston, H., Swales, J. D., Bing, R. F., et al. 1979. Vascular renin-like activity and blood pressure maintenance in the rat. Studies of the effect of changes in sodium balance, hypertension and nephrectomy. Hypertension 1 643-649. 

R.K. Zalups and M.G. Cherian, Renal metallothionein metabolism after a reduction of renal mass. I Effect of unilateral nephrectomy and compensatory renal growth on basal and metal induced renal metallothionein metabolism. Toxicology 71 83-102, 1992. 

R.K. Zalups, Autometallographic localization of inorganic mercury in the kidneys of the rats Effect of unilateral nephrectomy and compensatory renal growth. Exp. Molec. Pathol. 54 10-21, 1991. 

Sancho et al. (1989) used a similar procedure in rats ligating two of the three terminal branches of the left renal artery, followed by right nephrectomy. 

Subtotal (five-sixths) nephrectomy in rats has been used by many authors as model for chronic renal failure. Levine et al. (1997) used this model to evalu-... 

Kimura et al. (1999) reported a model of progressive chronic renal failure in rats, produced by a single injection of microspheres (20 to 30 pM in diameter) into the left renal artery after right nephrectomy. 

Stockelman et al. (1998) described chronic renal failure in a mouse model of human adenine phospho-ribo-syltransferase deficiency. Hamilton and Cotes (1994) used a partial nephrectomy model in mice with two-thirds of the total renal mass excised to evaluate erythropoiesis and erythropoietin production from extrarenal sources such as the submandibulary salivary gland. Koumegawa et al. (1991) suggested the DBA/2FG-pcy mouse, which develops numerous cysts in kidney cortex and medulla, a progressive anemia and an elevation of blood urea nitrogen, as a useful spontaneous model of progressive renal failure. 

Brown et al. (1990) studied the metabolism of erythropoietin in normal and uremic rabbits with 5/6 nephrectomy. Bonilla-Felix used rabbits after 75 % nephrectomy to study the response of cortical collecting ducts from remnant kidneys to arginine vasopressin. 

Castilho et al. (1990) studied the intestinal mucosal cholesterol synthesis in rats using a chronic bile duct-ureter fistula model. Male Wistar rats weighing 300-350 g were anesthetized with 50 mg/kg pentobarbital i.p. and submitted to a bile duct-right ureter fistula utilizing a PE-50 catheter after a right-kidney nephrectomy. 

Fortunately, the kidney has a remarkable ability to compensate for the loss of renal functional mass. Within a short time after unilateral nephrectomy, the remaining kidney hypertrophies such that overall renal function appears normal by standard clinical tests. Compensation becomes a problem when evaluating the effects of nephrotoxicants specifically, changes in kidney function may not be detected until the ability of the kidney to compensate is exceeded. Then, within a short period of time, an animal might develop life-threatening renal failure. 

---