Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Urol. 2013 Apr;189(4):1249-54. doi: 10.1016/j.juro.2012.11.043. Epub 2012 Nov 13.
We investigated the relationship between preoperative uric acid and the glomerular filtration rate preoperatively and postoperatively in patients with renal cell carcinoma.
Included in study were 1,534 patients who underwent radical or partial nephrectomy for renal cell carcinoma between 1994 and 2008. Uric acid was measured preoperatively. The estimated glomerular filtration rate was calculated using the MDRD (Modification of Diet in Renal Disease) equation preoperatively and postoperatively within 7 days, and at 3 months, and 1 and 3 years. We looked for correlations of uric acid with the glomerular filtration rate, patient demographics and comorbidities. We also evaluated the predictive value of uric acid for the preoperative glomerular filtration rate and new onset chronic kidney disease, defined as a glomerular filtration rate of less than 60 ml/minute/1.73 m(2), after nephrectomy using multivariate regression analysis.
Mean ± SD uric acid was 5.2 ± 1.5 mg/dl (range 1.3 to 11.3). Mean preoperative uric acid correlated with the preoperative glomerular filtration rate (r = -0.313, p <0.001) and was associated with prevalent chronic kidney disease. On multivariate regression analysis a decreased preoperative glomerular filtration rate correlated significantly with earlier year of surgery, older age, male gender, hypertension, high uric acid and larger tumors (each p <0.001). Hypertension, male gender and high body mass index correlated with high uric acid (each p <0.001). Older age (p <0.001), diabetes mellitus (p = 0.002), low preoperative glomerular filtration rate (p <0.001) and high preoperative uric acid (p = 0.002) were significant predictors of new onset chronic kidney disease 3 years after nephrectomy.
Increased preoperative uric acid was an independent predictor of a low preoperative glomerular filtration rate and new onset chronic kidney disease in patients with renal cell carcinoma who underwent nephrectomy.
我们研究了术前尿酸与肾细胞癌患者术前和术后肾小球滤过率之间的关系。
本研究纳入了 1994 年至 2008 年间接受根治性或部分肾切除术的 1534 例肾细胞癌患者。术前测量尿酸。术前和术后 7 天内，术后 3 个月、1 年和 3 年，使用 MDRD（肾脏病饮食改良）方程计算估计肾小球滤过率。我们寻找尿酸与肾小球滤过率、患者人口统计学和合并症之间的相关性。我们还使用多元回归分析评估尿酸对术前肾小球滤过率和术后新发慢性肾脏病（定义为肾小球滤过率低于 60ml/min/1.73m²）的预测价值。
尿酸的平均值±标准差为 5.2±1.5mg/dl（范围 1.3 至 11.3）。术前尿酸平均值与术前肾小球滤过率相关（r=-0.313，p<0.001），与现患慢性肾脏病相关。多元回归分析显示，术前肾小球滤过率降低与手术年份较早、年龄较大、男性、高血压、高尿酸和肿瘤较大显著相关（p<0.001）。高血压、男性和高体质指数与高尿酸相关（p<0.001）。年龄较大（p<0.001）、糖尿病（p=0.002）、术前肾小球滤过率较低（p<0.001）和术前尿酸较高（p=0.002）是术后 3 年新发慢性肾脏病的显著预测因素。
术前尿酸升高是肾细胞癌患者接受肾切除术时术前肾小球滤过率降低和新发慢性肾脏病的独立预测因素。
