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Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function

2018; Lippincott Williams & Wilkins; Volume: 200; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2018.07.042

1527-3792

Joseph Zabell, Sudhir Isharwal, Wen Dong, Joseph R. Abraham, Jitao Wu, Chalairat Suk‐Ouichai, Diego Aguilar Palacios, Erick M. Remer, Jianbo Li, Steven C. Campbell,

Chronic Kidney Disease and Diabetes

No AccessJournal of UrologyAdult Urology1 Dec 2018Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function Joseph Zabell, Sudhir Isharwal, Wen Dong, Joseph Abraham, Jitao Wu, Chalairat Suk-Ouichai, Diego Aguilar Palacios, Erick Remer, Jianbo Li, and Steven C. Campbell Joseph ZabellJoseph Zabell Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Equal study contribution. More articles by this author , Sudhir IsharwalSudhir Isharwal Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Equal study contribution. More articles by this author , Wen DongWen Dong Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China More articles by this author , Joseph AbrahamJoseph Abraham Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio More articles by this author , Jitao WuJitao Wu Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China More articles by this author , Chalairat Suk-OuichaiChalairat Suk-Ouichai Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author , Erick RemerErick Remer Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Radiology, Cleveland Clinic, Cleveland, Ohio More articles by this author , Jianbo LiJianbo Li Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , and Steven C. CampbellSteven C. Campbell Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.07.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Acute kidney injury often leads to chronic kidney disease in the general population. The long-term functional impact of acute kidney injury observed after partial nephrectomy has not been adequately studied. Materials and Methods: From 2004 to 2014 necessary studies for analysis were available for 90 solitary kidneys managed by partial nephrectomy. Functional data at 4 time points included preoperative serum creatinine, peak postoperative serum creatinine, new baseline serum creatinine 3 to 12 months postoperatively and long-term followup serum creatinine more than 12 months postoperatively. Adjusted acute kidney injury was defined by the ratio, observed peak postoperative serum creatinine/projected postoperative serum creatinine adjusted for parenchymal mass loss to reveal the true effect of ischemia. The long-term change in renal function (the long-term functional change ratio) was defined as the most recent glomerular filtration rate/the new baseline glomerular filtration rate. The relationship between the grade of the adjusted acute kidney injury and the long-term functional change was assessed by Spearman correlation analysis and multivariable regression. Results: Median patient age was 64 years and median followup was 45 months. Median parenchymal mass preservation was 80%. Adjusted acute kidney injury occurred in 42% of patients, including grade 1 injury in 20 (22%) and grade 2/3 in 18 (20%). On univariable analysis the degree of the adjusted acute kidney injury did not correlate with the long-term glomerular filtration rate change (p = 0.55). On multivariable analysis adjusted acute kidney injury was not associated with a long-term functional change (p >0.05) while diabetes and warm ischemia were modestly associated with a long-term functional decline (each p <0.05). Conclusions: Acute kidney injury after partial nephrectomy was not a significant or independent predictor of long-term functional decline in our institutional cohort. A prospective study with larger sample sizes and longer followup is required to evaluate factors associated with long-term nephron stability. References 1 : EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol2015; 67: 913. Google Scholar 2 : Renal mass and localized renal cancer: AUA guideline. J Urol2017; 198: 520. Link, Google Scholar 3 : Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol2001; 166: 6. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCampbell S (2020) Editorial CommentJournal of Urology, VOL. 205, NO. 3, (684-685), Online publication date: 1-Mar-2021.Laguna M (2020) Re: Impact of Acute Kidney Injury and its Duration on Long-Term Renal Function after Partial NephrectomyJournal of Urology, VOL. 203, NO. 4, (658-659), Online publication date: 1-Apr-2020. Volume 200Issue 6December 2018Page: 1295-1301Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsnephrectomyrenal insufficiencysolitary kidneyacute kidney injuryischemiachronicMetricsAuthor Information Joseph Zabell Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Equal study contribution. More articles by this author Sudhir Isharwal Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Equal study contribution. More articles by this author Wen Dong Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China More articles by this author Joseph Abraham Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio More articles by this author Jitao Wu Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China More articles by this author Chalairat Suk-Ouichai Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand More articles by this author Diego Aguilar Palacios Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Erick Remer Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Radiology, Cleveland Clinic, Cleveland, Ohio More articles by this author Jianbo Li Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Steven C. Campbell Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Expand All Advertisement PDF downloadLoading ...