Choi Kyung Hwa, Lee Seung Ryeol, Hong Young Kwon, Park Dong Soo
Department Urology, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea.
Department Urology, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea.
Urology. 2017 Jun;104:115-121. doi: 10.1016/j.urology.2017.02.022. Epub 2017 Feb 21.
To investigate whether the postnephrectomy renal adaptation mechanism, focused on functional hyperfiltration as well as structural hypertrophy, was affected by abdominal obesity.
We retrospectively evaluated 358 patients who underwent simple or radical nephrectomy and nephroureterectomy between 2009 and 2013. Patients were classified according to waist circumference (WC), with values >102 cm in men and >88 cm in women considered high (obesity). Functional renal volume (FRV) was measured using computed tomography performed preoperatively and 6 months postoperatively to evaluate the degree of remnant kidney hypertrophy. The degree of hyperfiltration was calculated from the difference between the preoperative and postoperative glomerular filtration rate (GFR)/FRV.
The mean preoperative GFR, FRV, and GFR/FRV were 72.1 mL/min/1.73 m, 282.8 cm, and 0.25 mL/min/1.73 m/cm, respectively. The percent GFR reduction was significantly greater in the high WC group (high, 25.9% vs normal, 16.0%, P = .036), although the degree of hypertrophic volume in the remnant kidney showed no difference. The change in GFR/FRV was statistically lower in the high WC group (high, 25.7% vs normal, 40.2%, P = .009). The factors associated with postoperative increased GFR/FRV were low preoperative GFR, proteinuria, high predictive preserved functional parenchymal volume ratio, absence of hypertension, increased levels of high-density lipoprotein cholesterol, and normal WC (all P < .05).
Patients with high WC might have a large reduction in postoperative renal function, owing to a lower degree of functional hyperfiltration.
研究以功能性超滤及结构肥大为主的肾切除术后肾脏适应机制是否受腹部肥胖影响。
我们回顾性评估了2009年至2013年间接受单纯或根治性肾切除术及肾输尿管切除术的358例患者。根据腰围（WC）对患者进行分类，男性WC>102 cm、女性WC>88 cm被视为高值（肥胖）。术前及术后6个月行计算机断层扫描测量功能性肾体积（FRV），以评估残余肾肥大程度。根据术前和术后肾小球滤过率（GFR）/FRV的差值计算超滤程度。
术前平均GFR、FRV和GFR/FRV分别为72.1 mL/min/1.73 m²、282.8 cm³和0.25 mL/min/1.73 m²/cm³。高WC组GFR降低百分比显著更高（高WC组为25.9%，正常组为16.0%，P = 0.036），尽管残余肾的肥大体积程度无差异。高WC组GFR/FRV的变化在统计学上更低（高WC组为25.7%，正常组为40.2%，P = 0.009）。与术后GFR/FRV升高相关的因素包括术前GFR低、蛋白尿、预测保留功能性实质体积比高、无高血压、高密度脂蛋白胆固醇水平升高及WC正常（均P < 0.05）。
高WC患者术后肾功能可能大幅降低，原因是功能性超滤程度较低。
