Zhang Zhiling, Zhao Juping, Dong Wen, Remer Eric, Li Jianbo, Demirjian Sevag, Zabell Joseph, Campbell Steven C
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Shanghai Jiao Tong University, School of Medicine, Ruijin Hospital, Department of Urology, Shanghai, China.
Eur Urol. 2016 Apr;69(4):745-752. doi: 10.1016/j.eururo.2015.10.023. Epub 2015 Oct 30.
Acute increase of serum creatinine (SCr) after partial nephrectomy (PN) is primarily due to parenchymal mass reduction or ischemia; however, only ischemia can impact subsequent functional recovery.
We evaluate etiologies of acute kidney injury (AKI) after PN and their prognostic significance.
DESIGN, SETTING, AND PARTICIPANTS: From 2007-2014, 83 solitary kidneys managed with PN had necessary studies for detailed analysis of function and parenchymal mass before/after surgery. AKI was classified by Risk/Injury/Failure/Loss/Endstage classification and defined by either standard criteria (comparison to preoperative SCr) or proposed criteria (comparison to projected postoperative SCr based on parenchymal mass reduction). Subsequent recovery was defined as percent function preserved/percent mass saved.
PN.
Predictive factors for AKI were evaluated by logistic regression. Relationship between AKI grade and subsequent functional recovery was assessed by linear regression.
Median duration warm ischemia (n=39) was 20 min and hypothermia (n=44) was 29 min. Median parenchymal mass reduction was 11%. AKI occurred in 45 patients based on standard criteria and 38 based on proposed criteria, and reflected injury/failure (grade = 2/3) in 23 and 16 patients, respectively. On multivariable analysis, only ischemia time associated with AKI occurrence (p=0.016). Based on the proposed criteria, median recovery from ischemia was 99% in patients without AKI and 95%/90%/88% for patients with grades 1/2/3 AKI, respectively. The coefficient for association between AKI grade based on proposed criteria and subsequent functional recovery was -4.168 (p=0.018). Main limitation is limited patient cohort.
Parenchymal mass reduction and ischemia both contribute to acute changes in SCr after PN. Classification of AKI by proposed criteria significantly associates with subsequent functional recovery. However, more robust numbers will be needed to further assess the merits of the proposed criteria. While AKI is associated with suboptimal recovery, even patients with grade 2/3 AKI reached 88-90% of recovery expected.
Acute decline in function after partial nephrectomy associates with more prolonged ischemia time, and appears to impact subsequent functional recovery. However, most kidneys eventually recover strongly, even if their function is sluggish in the first few days after surgery.
部分肾切除术后血清肌酐（SCr）急性升高主要归因于实质质量减少或缺血；然而，只有缺血会影响后续功能恢复。
我们评估部分肾切除术后急性肾损伤（AKI）的病因及其预后意义。
设计、设置和参与者：2007年至2014年，83例接受部分肾切除术的孤立肾患者在手术前后进行了详细的功能和实质质量研究，以进行详细分析。AKI根据风险/损伤/衰竭/丧失/终末期分类进行分类，并通过标准标准（与术前SCr比较）或建议标准（与基于实质质量减少的预计术后SCr比较）进行定义。随后的恢复定义为保留的功能百分比/保留的质量百分比。
部分肾切除术。
通过逻辑回归评估AKI的预测因素。通过线性回归评估AKI分级与随后功能恢复之间的关系。
39例患者的中位热缺血时间为20分钟，44例患者的中位低温时间为29分钟。实质质量减少的中位数为11%。根据标准标准，45例患者发生AKI，根据建议标准，38例患者发生AKI，分别有23例和16例患者表现为损伤/衰竭（2/3级）。在多变量分析中，只有缺血时间与AKI的发生相关（p=0.016）。根据建议标准，无AKI患者的缺血后中位恢复率为99%，1/2/3级AKI患者的恢复率分别为95%/90%/88%。根据建议标准的AKI分级与随后功能恢复之间的关联系数为-4.168（p=0.018）。主要局限性是患者队列有限。
实质质量减少和缺血均导致部分肾切除术后SCr的急性变化。根据建议标准对AKI进行分类与随后的功能恢复显著相关。然而，需要更多有力的数据来进一步评估建议标准的优点。虽然AKI与恢复不理想相关，但即使是2/3级AKI患者也达到了预期恢复的88-90%。
部分肾切除术后功能急性下降与更长的缺血时间相关，并且似乎会影响随后的功能恢复。然而，即使大多数肾脏在术后头几天功能迟缓，最终大多能强劲恢复。
