Jay Raman, Jung S B, Park B H, Jeong B C, Seo S I, Jeon S S, Lee H M, Choi H Y, Jeon H G
Urol Oncol. 2017 Mar;35(3):118-119. doi: 10.1016/j.urolonc.2016.12.024. Epub 2017 Feb 1.
We investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage.
We retrospectively identified 543 patients who underwent radical nephrectomy for renal cell carcinoma between 1997 and 2012. Patients were classified according to preoperative glomerular filtration rate as no chronic kidney disease-glomerular filtration rate 90ml/min/1.73m or greater (230, 42.4%), chronic kidney disease stage II-glomerular filtration rate 60 to less than 90ml/min/1.73m (227, 41.8%), and chronic kidney disease stage III-glomerular filtration rate 30 to less than 60ml/min/1.73m (86, 15.8%). Computerized tomography performed within 2 months before surgery and 1 year after surgery was used to assess functional renal volume for measuring the degree of hypertrophy of the remnant kidney, and the preoperative and postoperative glomerular filtration rate per unit volume of functional renal volume was used to calculate the degree of hyperfiltration.
Among all patients (mean age = 56.0y) mean preoperative glomerular filtration rate, functional renal volume, and glomerular filtration rate/functional renal volume were 83.2ml/min/1.73m, 340.6cm, and 0.25ml/min/1.73m/cm, respectively. The percent reduction in glomerular filtration rate was statistically significant according to chronic kidney disease stage (no chronic kidney disease 31.2% vs. stage II 26.5% vs. stage III 12.8%, P<0.001). However, the degree of hypertrophic functional renal volume in the remnant kidney was not statistically significant (no chronic kidney disease 18.5% vs. stage II 17.3% vs. stage III 16.5%, P = 0.250). The change in glomerular filtration rate/functional renal volume was statistically significant (no chronic kidney disease 18.5% vs. stage II 20.1% vs. stage III 45.9%, P<0.001). Factors that increased glomerular filtration rate/functional renal volume above the mean value were body mass index (P = 0.012), diabetes mellitus (P = 0.023), hypertension (P = 0.015), and chronic kidney disease stage (P<0.001).
Patients with a lower preoperative glomerular filtration rate had a smaller reduction in postoperative renal function than those with a higher preoperative glomerular filtration rate due to greater degrees of functional hyperfiltration.
我们根据术前慢性肾脏病分期，研究了肾细胞癌患者根治性肾切除术后作为代偿性适应的结构肥大和功能性超滤。
我们回顾性纳入了1997年至2012年间接受根治性肾切除术治疗肾细胞癌的543例患者。根据术前肾小球滤过率将患者分类为无慢性肾脏病（肾小球滤过率≥90ml/min/1.73m²，230例，42.4%）、慢性肾脏病II期（肾小球滤过率60至<90ml/min/1.73m²，227例，41.8%）和慢性肾脏病III期（肾小球滤过率30至<60ml/min/1.73m²，86例，15.8%）。术前2个月内及术后1年进行的计算机断层扫描用于评估功能性肾体积，以测量残余肾的肥大程度，术前和术后每单位功能性肾体积的肾小球滤过率用于计算超滤程度。
在所有患者（平均年龄=56.0岁）中，术前平均肾小球滤过率、功能性肾体积和肾小球滤过率/功能性肾体积分别为83.2ml/min/1.73m²、340.6cm³和0.25ml/min/1.73m²/cm³。根据慢性肾脏病分期，肾小球滤过率降低的百分比具有统计学意义（无慢性肾脏病为31.2%，II期为26.5%，III期为12.8%，P<0.001）。然而，残余肾的肥大功能性肾体积程度无统计学意义（无慢性肾脏病为18.5%，II期为17.3%，III期为16.5%，P = 0.250）。肾小球滤过率/功能性肾体积的变化具有统计学意义（无慢性肾脏病为18.5%，II期为20.1%，III期为45.9%，P<0.001）。使肾小球滤过率/功能性肾体积高于平均值增加的因素有体重指数（P = 0.012）、糖尿病（P = 0.023）、高血压（P = 0.015）和慢性肾脏病分期（P<0.001）。
术前肾小球滤过率较低的患者术后肾功能降低幅度小于术前肾小球滤过率较高的患者，这是由于功能性超滤程度更高。
