Follow-up study of unilateral renal function after nephrectomy assessed by glomerular filtration rate per functional renal volume

Abstract

BackgroundTo evaluate the clinical usefulness of estimated glomerular filtration rate (eGFR) divided by functional renal volume (FRV) measured by three-dimensional image reconstruction (eGFR/FRV) for the prediction of functional outcomes after nephrectomy.MethodsEighty-three patients who underwent nephrectomy were enrolled. The FRV of each patient was measured before surgery. Preoperative medical information on proteinuria, blood pressure, blood glucose level, body mass index (BMI), hemoglobin level and serum cholesterol level were also obtained. We evaluated the relationships between eGFR/FRV and each of these parameters before surgery. We also assessed the potential relationship between eGFR/FRV and the 3-year postoperative eGFR. Stepwise multiple regression analyses were conducted to elucidate independent factors.ResultsThe median FRV and eGFR were 310.15 cm3 and 79.0 ml/min/1.73 m2 before surgery, respectively. The correlation between FRV and eGFR was statistically significant (r = 0.465, P < 0.001). The median eGFR/FRV was 0.24 ml/min/1.73 m2/cm3. Stepwise multiple regression analysis showed that the independent parameters (multiple correlation coefficient, r = 0.389, P = 0.031) associated with eGFR/FRV were proteinuria, BMI, age and hypertension. Proteinuria was statistically associated with eGFR/FRV, and the independent parameters (multiple correlation coefficient, r = 0.694, P < 0.001) associated with the 3-year postoperative eGFR were age, BMI and eGFR/FRV. The eGFR/FRV was statistically associated with the 3-year postoperative eGFR (r = 0.559, P < 0.001).ConclusionThe present results demonstrated that patients with proteinuria are expected to have a lower eGFR/FRV than those without proteinuria. The present study also supports the notion that eGFR/FRV is the primary determinant of the long-term functional outcome after nephrectomy. It should be taken into consideration that patients with a low eGFR/FRV may develop chronic kidney disease after nephrectomy.

Compensatory Structural and Functional Adaptation after Radical Nephrectomy for Renal Cell Carcinoma According to Preoperative Stage of Chronic Kidney Disease

“…24,25 Hosokawa et al assessed preoperative GFR per unit of functional renal volume and found it was a causative factor for postoperative proteinuria. 26 However, they did not estimate postoperative GFR per unit of functional renal volume, and the cohorts did not distinguish between patients who had undergone donor nephrectomy, nephroureterectomy and RN for RCC, precluding appropriate appraisal of the usefulness of GFR per unit of functional volume. Nevertheless, in the present study we estimated renal volume before and after surgery, and assessed the GFR/FRV to evaluate the degree of compensatory functional adaptation 1 year after RN.…”

Ultrastructural changes and nestin expression accompanying compensatory renal growth after unilateral nephrectomy in adult rats

“…Unilateral nephrectomy is a major surgery indicated for kidney donation 1 or conditions that lead to poorly functioning or nonfunctioning kidney as renal cell or urothelial cancer. 2 After unilateral nephrectomy, the remaining kidney undergoes structural and functional changes as a pliant response to quench the increased functional demand to maintain the homeostasis of fluid and solutes in the body.…”

The Effect of Low FT3 Level on Kidney Disease Progression and Potassium Levels in Euthyroid Adult Patients with Solitary Kidney

“…This may suggest that patients with low FT3 levels are hypervolemic and through secondary inhibition of the RAS system, they are prone to be hyperkalemic. Nephrectomy is a risk factor for CKD development and even in healthy individuals with donor nephrectomy, progression to end-stage renal disease (ESRD) is possible both after indication and donor nephrectomy; basically the renal residual volume but also age, obesity and the presence of co-morbid conditions such as diabetes and hypertension are important for predicting the progression of renal disease (9)(10)(11)25). However, in these patients, the effect of thyroid function on renal outcome is unknown.…”

“…In these patients; hypertension, proteinuria, obesity and metabolic syndrome are major risk factors for CKD progression and electrolyte abnormalities including hyperkalemia are common (9,11). However, the impact of thyroid dysfunction on CKD progression is not clear.…”