Comparison of warm and cold ischemia on renal function after partial nephrectomy

Urology. 2014 Dec;84(6):1408-12. doi: 10.1016/j.urology.2014.08.040.


Objective: To assess renal functional deterioration after partial nephrectomy with warm and cold ischemia using (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scintigraphy parameters.

Methods: Open partial nephrectomy was performed in 59 patients with warm ischemia and 64 patients with cold ischemia. (99m)Tc-MAG3 renal scintigraphy was performed and effective renal plasma flow was calculated to evaluate split renal function. In addition, regional (99m)Tc-MAG3 uptake was analyzed in the surgically unaffected parts to evaluate ischemic damage.

Results: The mean tumor size in the warm and cold ischemia groups was 2.9 and 3.2 cm, respectively, and the mean ischemic time was 24.2 minutes (range, 8-46 minutes) and 26.7 min (range, 8-58 minutes), respectively. One week after surgery, effective renal plasma flow in the operated kidney decreased to 66.2% (from 160.2 to 105.4 mL/min/1.73 m(2)) in the warm ischemia group and to 77.4% (from 152.3 to 116.6 mL/min/1.73 m(2)) in the cold ischemia group. Regional (99m)Tc-MAG3 uptake changed to 89.2% of baseline in the warm ischemia group and 101.5% of baseline in the cold ischemia group. When the ischemic time was ≥ 25 minutes, regional (99m)Tc-MAG3 uptake in the warm ischemia group did not recover to the baseline level at 6 months. Multiple regression analyses demonstrated a significant correlation between ischemic time and the decrease in regional (99m)Tc-MAG3 uptake in the warm ischemia group, but not in the cold ischemia group.

Conclusion: Warm ischemia for ≥ 25 minutes caused long lasting diffuse damage throughout the operated kidney, whereas cold ischemia for up to 58 minutes prevented ischemic injury to the renal remnant.

Publication types

  • Comparative Study

MeSH terms

  • Chi-Square Distribution
  • Cohort Studies
  • Cold Ischemia / adverse effects
  • Cold Ischemia / methods*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Kidney Function Tests
  • Kidney Neoplasms / diagnostic imaging
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Male
  • Multivariate Analysis
  • Nephrectomy / adverse effects
  • Nephrectomy / methods*
  • Postoperative Care / methods
  • Postoperative Complications / pathology
  • Postoperative Complications / physiopathology
  • Radionuclide Imaging
  • Regression Analysis
  • Retrospective Studies
  • Technetium Tc 99m Mertiatide*
  • Time Factors
  • Treatment Outcome
  • Warm Ischemia / adverse effects
  • Warm Ischemia / methods*


  • Technetium Tc 99m Mertiatide