Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia, USA.
J Endourol. 2010 Mar;24(3):479-82. doi: 10.1089/end.2009.0186.
Renal function outcomes after renal cryosurgery have not been widely scrutinized. We report 2-year renal function outcomes from a single-center cohort of patients who were treated with cryoablation for small renal masses.
We performed a retrospective review of our laparoscopic and percutaneous renal cryoablation experience between January 2003 and April 2007. Global renal function was assessed using measured serum creatinine and estimated glomerular filtration rate (eGFR) (MDRD equation). Chronic kidney disease (CKD) was defined as a serum creatinine level >2.0 mg/dL or eGFR <60 mL/min/1.73 m(2).
Sixty-two patients were included in the analysis. Mean follow-up was 30 months (range 13-63 mos). Mean tumor size was 2.33 cm (range 1-4.6 cm). Comorbid conditions were prevalent: 77% hypertension, 35% hyperlipidemia, 31% diabetes mellitus, 39% tobacco use, and 32% heart disease (coronary artery disease/congestive heart failure). Based on eGFR calculations, preoperative CKD was noted in 17 of 62 (27%) patients. De novo CKD was noted in 5 of 45 (11%) patients. Patients in whom de novo CKD developed had lower pretreatment eGFR (71.0 vs 98.4 60 mL/min/1.73 m(2), P = 0.03) and larger tumor size (2.94 vs 2.19 cm, P = 0.04) compared with patients who were maintaining normal renal function. When CKD was defined as creatinine level >2.0 mg/dL, only one and six patients were identified with preoperative and de novo CKD, respectively.
In a cohort of renal cryosurgery patients who were characterized by highly prevalent medical comorbidities, renal function was generally well maintained, with a low rate of de novo CKD based on eGFR calculations. A serum creatinine level >2.0 mg/dL was a less sensitive measure of CKD.
肾冷冻消融术后的肾功能结果尚未得到广泛研究。我们报告了单中心队列中 62 例接受冷冻消融术治疗小肾肿瘤患者的 2 年肾功能结果。
我们对 2003 年 1 月至 2007 年 4 月期间我们的腹腔镜和经皮肾冷冻消融经验进行了回顾性分析。使用测量的血清肌酐和估算的肾小球滤过率（MDRD 方程）评估整体肾功能。慢性肾脏病（CKD）定义为血清肌酐水平＞2.0mg/dL 或 eGFR＜60mL/min/1.73m²。
62 例患者纳入分析。平均随访时间为 30 个月（范围 13-63 个月）。平均肿瘤大小为 2.33cm（范围 1-4.6cm）。合并症普遍存在：77%高血压、35%高脂血症、31%糖尿病、39%吸烟和 32%心脏病（冠心病/充血性心力衰竭）。根据 eGFR 计算，术前 62 例患者中有 17 例（27%）患有 CKD。45 例中有 5 例（11%）新发生 CKD。发生新 CKD 的患者的术前 eGFR 较低（71.0 vs 98.460mL/min/1.73m²，P=0.03）且肿瘤较大（2.94 vs 2.19cm，P=0.04）与保持正常肾功能的患者相比。当 CKD 定义为血清肌酐水平＞2.0mg/dL 时，术前和新发生 CKD 的患者分别只有 1 例和 6 例。
在一组以高发合并症为特征的肾冷冻消融术患者中，基于 eGFR 计算，肾功能总体维持良好，新发生 CKD 的发生率较低。血清肌酐水平＞2.0mg/dL 是 CKD 的一种较不敏感的衡量标准。
