Partial nephrectomy(PN)is the optimal treatment of localized small renal masses.In most cases,PN is performed with renal artery occlusion to maintain clear visualization,which leads to ipsilateral ischemia reperfusion injury and acute kidney injury(AKI)in severe cases.AKI after PN is generally evaluated with AKIN or RIFLE criteria.However,the increased level of total creatinine is clearly not accurate enough to assess unilateral kidney injury,because unilateral injury and loss of normal renal parenchyma also induce increase of serum creatinine.In order to avoid the interference of the above factors to the diagnosis,we modified AKI criteria in renal cancer patients with solitary kidney and emphasized that the role of parenchymal mass reduction should always be considered during AKI evaluation.We used"Extreme Value Theory"and quantified the degree of AKI in renal cancer patients who have a functional contralateral kidney.Furthermore,we discussed the long-term impact of AKI on the operated kidney and potential methods to alleviate ischemic injury during PN.
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