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

Kara, Önder; Maurice, Matthew J.; Mouracadé, Pascal; Malkoç, Ercan; Dagenais, Julien; Çapraz, Mustafa; Chavali, Jaya Sai; Kara, Merve Yazıcı; Kaouk, Jihad

doi:10.1590/s1677-5538.ibju.2018.0776

Cited by 4 publications

(1 citation statement)

References 37 publications

(38 reference statements)

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“…In addition, potential risk factors (i.e., diabetes, hypertension control status, proteinuria) were not accessible during the follow-up. Proteinuria was proved to be strongly correlated with postoperative AKI, functional decline [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy

Zhang,

Jin,

Zhang

et al. 2023

BMC Urol

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Purpose Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is understood about this possibility among kidney surgical populations. This study aimed to elucidate the incidence of AKD after partial nephrectomy and risk factors that promote the AKI to AKD transition. Methods From January 2010 to January 2020, this study retrospectively collected a dataset of consecutive patients with renal masses undergoing partial nephrectomy in 4 urological centers. Cox proportional regression analyses were adopted to identify risk factors that promoted the AKI to AKD transition. To avoid overfitting, the results were then verified by logistic least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then constructed and validated for AKI to AKD transition prediction. Results AKI and AKD occurred in 228 (21.4%) and 42 (3.9%) patients among a total of 1062 patients, respectively. In patients with AKI, multivariable Cox regression analysis and LASSO regression identified that age (HR 1.078, 1.029–1.112, p < 0.001), baseline eGFR (HR 1.015, 1.001–1.030, p < 0.001), RENAL score (HR1.612, 1.067–2.437, p = 0.023), ischemia time > 30 min (HR 7.284, 2.210–23.999, p = 0.001), and intraoperative blood loss > 300ml (HR 8.641, 2.751–27.171, p < 0.001) were risk factors for AKD transition. These five risk factors were then integrated into a nomogram. The nomogram showed excellent discrimination, calibration, and clinical net benefit ability. Conclusion Around 3.9% patients following partial nephrectomy would transit from AKI to AKD. Intraoperative blood loss and ischemia time need to be diminished to avoid on-going functional decline. Our nomogram can accurately predict the transition from AKI to AKD.

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Section: Discussionmentioning

confidence: 99%

Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy

Zhang,

Jin,

Zhang

et al. 2023

BMC Urol

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Severe acute kidney disease is associated with worse kidney outcome among acute kidney injury patients

Chen

Mao

et al. 2022

Sci Rep

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Acute kidney disease (AKD) comprises acute kidney injury (AKI). However, whether the AKD staging system has prognostic values among AKI patients with different baseline estimated glomerular filtration (eGFR) remains a controversial issue. Algorithm-based approach was applied to identify AKI occurrence and to define different AKD stages. Risk ratio for major adverse kidney events (MAKE), including (1) eGFR decline > 35% from baseline, (2) initiation of dialysis, (3) in-hospital mortality of different AKD subgroups were identified by multivariable logistic regression. Among the 4741 AKI patients identified from January 2015 to December 2018, AKD stages 1–3 after AKI was common (53% in the lower baseline eGFR group and 51% in the higher baseline eGFR group). In the logistic regression model adjusted for demographics and comorbidities at 1-year follow-up, AKD stages 1/2/3 (AKD stage 0 as reference group) were associated with higher risks of MAKE (AKD stage: odds ratio, 95% confidence interval [95% CI], AKD 1: 1.85, 1.56–2.19; AKD 2: 3.43, 2.85–4.12; AKD 3: 10.41, 8.68–12.49). Regardless of baseline eGFR, staging criteria for AKD identified AKI patients who were at higher risk of kidney function decline, dialysis and mortality. Post-AKI AKD patients with severer stage need intensified care and timely intervention.

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Pre-operative proteinuria and post-operative acute kidney injury in noncardiac surgery: the NARA-Acute Kidney Injury cohort study

Nishimoto

Murashima

Kokubu³

et al. 2019

Nephrology Dialysis Transplantation

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Background Little is known about the association between pre-operative proteinuria and post-operative acute kidney injury (AKI) in noncardiac surgery. Methods This is a retrospective cohort study. Adults who underwent noncardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University Hospital were included. Those with obstetric or urological surgery, missing data for analyses or pre-operative dialysis were excluded. Exposure of interest was pre-operative proteinuria, defined as (+) or more by dipstick test. The outcome variable was post-operative AKI, defined by Kidney Disease: Improving Global Outcomes criteria, within 1 week after surgery. Multivariable logistic regression analyses were performed. Results Among 5168 subjects, 309 (6.0%) developed AKI. Pre-operative proteinuria was independently associated with post-operative AKI, with an odds ratio (OR) [95% confidence interval (CI)] of 1.80 (1.30–2.51). A sensitivity analysis restricted to elective surgery yielded a similar result. As proteinuria increased, the association with AKI became stronger [OR (95% CI) 1.14 (0.75–1.73), 1.24 (0.79–1.95), 2.75 (1.74–4.35) and 3.95 (1.62–9.62) for urinary protein (+/−), (+), (2+) and (3+), respectively]. Subgroup analyses showed proteinuria was especially associated with post-operative AKI among subjects with renin–angiotensin system inhibitors, other anti-hypertensives, hypoalbuminemia or impaired renal function (P for interaction = 0.05, 0.003, 0.09 or 0.02, respectively). Conclusions In noncardiac surgery, pre-operative proteinuria was independently associated with post-operative AKI. Subjects with proteinuria should be managed with caution to avoid AKI peri-operatively.

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

Cited by 4 publications

References 37 publications

Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy

Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy

Severe acute kidney disease is associated with worse kidney outcome among acute kidney injury patients

Pre-operative proteinuria and post-operative acute kidney injury in noncardiac surgery: the NARA-Acute Kidney Injury cohort study

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