Predicting Renal Function Outcomes After Partial and Radical Nephrectomy

Bhindi, Bimal; Lohse, Christine M.; Schulte, Phillip J.; Mason, Ross; Cheville, John C.; Boorjian, Stephen A.; Leibovich, Bradley C.; Thompson, R. Houston

doi:10.1016/j.eururo.2018.11.021

Cited by 84 publications

(79 citation statements)

References 38 publications

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“…Patients with proteinuria had 2.4-fold higher odds of AKI than patients without proteinuria. These results are consistent with prior studies that have shown an association between proteinuria and AKI after non-renal (26-28), and renal surgeries (29). Surprisingly, in our study, preoperative proteinuria was not a predictor of long-term renal functional preservation.…”

Section: Discussionsupporting

confidence: 93%

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

et al. 2019

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Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN).Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI.Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04).Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

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Section: Discussionsupporting

confidence: 93%

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

et al. 2019

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“…Most of these determinants are non-modifiable, such as the age and comorbidities of the patient that determine the general quality of the nephrons and the vascular health. [1][2][3][4] Kidney size, tumor size and location are also non-modifiable factors themselves, which also impact subsequent surgical factors, such as WIT and excised parenchymal volume. [5][6][7] Modifiable determinants of renal function after PN are limited to a few surgical factors and the resultant variabilities, such as the WIT.…”

Section: Introductionmentioning

confidence: 99%

“…Interrelated patient factors, tumor factors and surgical factors, as well as postsurgical factors, all contribute in varying degrees to determining postoperative renal function, immediately as well as in the long term. Most of these determinants are non‐modifiable, such as the age and comorbidities of the patient that determine the general quality of the nephrons and the vascular health 1–4 . Kidney size, tumor size and location are also non‐modifiable factors themselves, which also impact subsequent surgical factors, such as WIT and excised parenchymal volume 5–7 .…”

Section: Introductionmentioning

confidence: 99%

Surgical details and renal function change after robot‐assisted partial nephrectomy

et al. 2020

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Abbreviations & Acronyms BMI = body mass index CI = confidence interval CKD = chronic kidney disease CT = computed tomography DM = diabetes mellitus DTPA = diethylenetetramine pentaacetic acid GFR = glomerular filtration rate IQR = interquartile range PN = partial nephrectomy RAPN = robot-assisted partial nephrectomy WIT = warm ischemic time Objectives: To investigate whether differences in surgical details during robot-assisted partial nephrectomy impact postoperative renal function. Methods: Patient, tumor and perioperative characteristics of 751 patients who underwent robot-assisted partial nephrectomy were analyzed with respect to the difference in ipsilateral glomerular filtration rate measured by diethylenetetramine pentaacetic acid renal scan. Detailed surgical methods defined for tumor excision (cutting vs splitting), hemostasis (suturing vs clipping) and renorrhaphy (continuous vs interrupted) were analyzed for early glomerular filtration rate decline and long-term recovery.Results: The glomerular filtration rate of the entire cohort decreased by 9.8 mL/min/ 1.73 m 2 (22%) at 3 months postoperatively, gradually increasing thereafter. The recovery slope was 1.7 mL/min/1.73 m 2 /year during a median follow-up period of 23.0 months. Early glomerular filtration rate decline was more pronounced in the cutting group (23.5 vs 20.1%, P = 0.009). Clipping was associated with less glomerular filtration rate decline throughout the observation period, and the recovery slope was also significantly higher (2.7 vs 1.1 mL/min/1.73 m 2 /year). In multivariate analysis, early decline was associated with age, preoperative glomerular filtration rate, parenchymal volume loss and ischemia >25 min. With respect to long-term recovery, suturing had the greatest adverse impact (b = À5.060, P < 0.0001, 95% confidence interval À7.709, À2.411) in addition to parenchymal volume reduction and early decline. In the propensity-matched cohort accounting for differences in tumor size and complexity, suturing was persistently associated with a significant glomerular filtration rate decline until >2 years after surgery. Conclusions: Hemostatic sutures during robot-assisted partial nephrectomy might interfere with long-term renal function recovery irrespective of parameters that determine the initial function change. As the splitting method reduces the use of sutures, modifying these details might help preserve renal function.

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“…Recent studies reported that the model to predict eGFR after PN included renal ischemia time, age, presence of a solitary kidney, diabetes, hypertension, preoperative eGFR, preoperative proteinuria, surgical approach, time from surgery, etc. [6]. In addition, it has been reported that during cardiopulmonary bypass (CPB) haemodilution develops, which is useful in reducing the risk of thrombosis, but decreases oxygen transfer and provokes tissue hypoxia, which can lead to acute organ damage.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Anaemia is a Risk Factor of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy

Zhang

Duan

et al. 2020

Preprint

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Background Acute kidney injury (AKI) secondary to partial nephrectomy (PN) is a challenging clinical issue. During PN anaemia develops due to haemodilution and blood loss, which decreases oxygen transfer and provokes tissue hypoxia, leading to postoperative adverse outcomes. The aim of this study was to investigate the impact of perioperative anaemia on postoperative AKI after PN.Methods This retrospective cohort study included 68 adult patients undergoing PN for a single nonmetastatic renal tumor. Detailed clinical information was systematically reviewed and analyzed. Serum concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and creatinine (sCr) were tested before, 2 hours and 1 day after PN surgery. Perioperative anaemia was assessed according to haematocrit (Ht) value at the same timepoint. Association between perioperative anaemia and postoperative AKI were explored by logistic regression analyses and pearson correlation analysis. Results The rate of perioperative anaemia in patients undergoing PN was 35.3% when the criteria of Ht < 30% was adopted. AKI developed in 32.4% of the patients when KDIGO criteria was applicated and in 51.5% of the patients when the criteria of serum NGAL >150 ng/mL was used. The incidence of AKI in patients with perioperative anaemia was higher than that in patients without anaemia. Univariate logistic regression analyses showed perioperative anaemia was a relevant factor of postoperative AKI in patients undergoing PN.Conclusions Perioperative anaemia might be a risk factor of postoperative AKI after PN. But the detailed interrelation still needs to be verified by large-scale prospective studies.

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Predicting Renal Function Outcomes After Partial and Radical Nephrectomy

Cited by 84 publications

References 38 publications

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

Surgical details and renal function change after robot‐assisted partial nephrectomy

Perioperative Anaemia is a Risk Factor of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy

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