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Effect of ulinastatin on postoperative renal function in patients undergoing robot-assisted laparoscopic partial nephrectomy: a randomized trial

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Abstract

Background

Robot-assisted laparoscopic partial nephrectomy (RLPN) is an emerging technique for treating small renal masses. Although RLPN has many advantages, ischemic kidney injury is inevitable during renal artery clamping. The overall incidence of acute kidney injury (AKI) after partial nephrectomy has been reported to be up to 39%. Moreover, effective pharmacological protection against AKI after partial nephrectomy has not yet been demonstrated. Ulinastatin has been shown to protect the kidney from ischemia/reperfusion injury via its anti-inflammatory and anti-oxidant activities. Therefore, this study aimed to evaluate the effect of ulinastatin on postoperative kidney function in patients undergoing RLPN.

Methods

In this randomized, double-blinded, placebo-controlled study, patients undergoing RLPN received either intravenous ulinastatin (100,000 units/10 kg; ulinastatin group, n = 35) or the same volume of normal saline (control group, n = 35) for 1 h starting 10 min before renal artery clamping. The primary outcome was incidence of postoperative AKI. Secondary outcomes were levels of serum creatinine, estimated glomerular filtration rate (eGFR), cystatin C, and inflammatory markers and were measured before operation and at 1, 24, 48, and 72 h postoperatively.

Results

The incidence of postoperative AKI was 18% in the ulinastatin group, whereas it was 30% in the control group (p = 0.251). No significant differences in postoperative changes of serum creatinine, eGFR, or cystatin C were observed between the two groups. Postoperative inflammatory markers including C-reactive protein, white blood cell count, and neutrophil percentage were significantly increased until 72 h after operation compared to the preoperative values in both groups, with no significant differences between the groups.

Conclusions

Administration of ulinastatin (100,000 units/10 kg) during the warm ischemia and reperfusion periods did not show any beneficial effects on postoperative kidney function or inflammatory responses in patients undergoing RLPN.

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Acknowledgements

The authors thank the biostatisticians for their statistical comments and analysis and Dong-Su Jang, MFA, medical illustrator, for his help with the figures in the Medical Research Support Section, Yonsei University College of Medicine.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Bora Lee, Na Young Kim, Sujung Park & So Yeon Kim

  2. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Bora Lee, Na Young Kim & So Yeon Kim

  3. Department of Anesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea

    Sook Young Lee

  4. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Koon Ho Rha & Young Deuk Choi

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  1. Bora Lee
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Correspondence to So Yeon Kim.

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Bora Lee, Sook Young Lee, Na Young Kim, Koon Ho Rha, Young Deuk Choi, Sujung Park, and So Yeon Kim have no conflicts of interest or financial ties to disclose.

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Lee, B., Lee, S.Y., Kim, N.Y. et al. Effect of ulinastatin on postoperative renal function in patients undergoing robot-assisted laparoscopic partial nephrectomy: a randomized trial. Surg Endosc 31, 3728–3736 (2017). https://doi.org/10.1007/s00464-017-5608-8

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