Krebs R K, Andreoni C, Ortiz V
Division of Urology, Federal University of São Paulo, São Paulo, Brazil.
Urol Int. 2014;92(4):449-54. doi: 10.1159/000355609. Epub 2014 Apr 9.
To evaluate renal function in renal cancer patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) (open or laparoscopic - ORN, OPN, LRN or LPN) and to identify risk factors contributing to renal function loss.
We analysed 228 consecutive renal cancer patients admitted for OPN, LPN, ORN or LRN. The variables analysed were age, gender, weight, type of surgery (radical versus partial), type of surgical access (open versus laparoscopic), preoperative renal function and history of hypertension, diabetes or malignancy. Absolute renal function was calculated as the difference in glomerular filtration rate (ΔGFR) between the renal function before (GFR0) and 12 months after surgery (GFR12). The relative renal function of patients undergoing PN and RN was evaluated by the change in chronic kidney disease stage.
LRN caused the greatest loss in absolute renal function, followed by ORN, LPN and OPN. A GFR of ≥60 ml/min was noted for 90 (68.7%) patients before and 65 (49.6%) patients after RN and for 80 (82.5%) patients before and 74 (76.3%) patients after PN. The chronic kidney disease stage dropped to 4 or 5 in the case of 6 (4.6%) patients who underwent RN and 2 (2.1%) patients who underwent PN. Multivariate analysis revealed that only preoperative weight and type of surgery (radical versus partial) had a significant impact on renal function.
Renal function significantly decreased in patients undergoing RN, irrespective of the access route. Patients with preoperative poor renal function are at risk of postoperative end-stage renal disease.
评估接受根治性肾切除术（RN）或部分肾切除术（PN）（开放或腹腔镜手术——ORN、OPN、LRN或LPN）的肾癌患者的肾功能，并确定导致肾功能丧失的危险因素。
我们分析了228例连续入院接受OPN、LPN、ORN或LRN的肾癌患者。分析的变量包括年龄、性别、体重、手术类型（根治性与部分性）、手术入路类型（开放与腹腔镜）、术前肾功能以及高血压、糖尿病或恶性肿瘤病史。绝对肾功能计算为术前（GFR0）和术后12个月（GFR12）的肾小球滤过率差值（ΔGFR）。通过慢性肾脏病分期的变化评估接受PN和RN患者的相对肾功能。
LRN导致的绝对肾功能丧失最大，其次是ORN、LPN和OPN。RN术前90例（68.7%）患者和术后65例（49.6%）患者的肾小球滤过率≥60 ml/min，PN术前80例（82.5%）患者和术后74例（76.3%）患者的肾小球滤过率≥60 ml/min。接受RN的6例（4.6%）患者和接受PN的2例（2.1%）患者的慢性肾脏病分期降至4期或5期。多因素分析显示，只有术前体重和手术类型（根治性与部分性）对肾功能有显著影响。
接受RN的患者肾功能显著下降，无论手术入路如何。术前肾功能差的患者有术后终末期肾病的风险。
