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Advances in Urology
Volume 2008, Article ID 102461, 10 pages
http://dx.doi.org/10.1155/2008/102461
Review Article

Importance and Limits of Ischemia in Renal Partial Surgery: Experimental and Clinical Research

Urology Section, CEMIC University Hospital, Buenos Aires C1431FWO, Argentina

Received 29 February 2008; Accepted 18 June 2008

Academic Editor: J. Rubio

Copyright © 2008 Fernando P. Secin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. The objective is to determine the clinical and experimental evidences of the renal responses to warm and cold ischemia, kidney tolerability, and available practical techniques of protecting the kidney during nephron-sparing surgery. Materials and methods. Review of the English and non-English literature using MEDLINE, MD Consult, and urology textbooks. Results and discussion. There are three main mechanisms of ischemic renal injury, including persistent vasoconstriction with an abnormal endothelial cell compensatory response, tubular obstruction with backflow of urine, and reperfusion injury. Controversy persists on the maximal kidney tolerability to warm ischemia (WI), which can be influenced by surgical technique, patient age, presence of collateral vascularization, indemnity of the arterial bed, and so forth. Conclusions. When WI time is expected to exceed from 20 to 30 minutes, especially in patients whose baseline medical characteristics put them at potentially higher, though unproven, risks of ischemic damage, local renal hypothermia should be used.