Department of Urology, Toho University Sakura Medical Center, Shimoshizu 564-1, Sakura-Shi, Chiba, 285-8741, Japan.
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
World J Urol. 2017 Oct;35(10):1577-1583. doi: 10.1007/s00345-017-2033-5. Epub 2017 Apr 11.
Most patients with primary aldosteronism (PA) show a significant decrease in kidney function after surgery. Glomerular hyperfiltration peculiar to PA can mask mild renal failure before surgery. The aim of this retrospective study was to investigate postoperative renal functional outcomes in PA patients from different viewpoints and to develop novel nomograms that can predict renal functional outcomes in PA patients after surgery.
130 Japanese PA patients treated by unilateral laparoscopic adrenalectomy were retrospectively surveyed. Pre- and postoperative changes of estimated glomerular filtration rates (eGFRs) and the distribution of eGFR classification were compared. Furthermore, predictors of the following renal functional outcomes were investigated: (I) the percentage decrease >25% in eGFR and (II) the presence of new-onset eGFR <45 ml/min/1.73 m. Finally, two nomograms that predicted postoperative renal functional outcomes were developed and internally validated.
At 6 months, the average decrease in eGFR was 16.7 mL/min/1.73 m (corresponding percent decrease: 19.7%). Upstaging of eGFR classification was observed in 54.6% of patients. Age, potassium, plasma aldosterone concentration, and initial eGFR were incorporated into a nomogram predicting a >25% postoperative decrease in eGFR. Duration of hypertension and initial eGFR were incorporated into a nomogram predicting new-onset eGFR <45 ml/min/1.73 m. The value of the area under the receiver operating characteristics curve for each nomogram was 0.82 and 0.74, respectively.
The first nomograms that can predict postoperative renal outcomes in PA patients were developed. They will help clinicians calculate the probability of renal dysfunction in PA patients after laparoscopic adrenalectomy.
大多数原发性醛固酮增多症（PA）患者术后肾功能明显下降。PA 特有的肾小球高滤过在术前可能掩盖轻度肾功能衰竭。本回顾性研究的目的是从不同角度探讨 PA 患者术后肾功能结局，并开发新的列线图以预测 PA 患者术后肾功能结局。
回顾性调查了 130 例接受单侧腹腔镜肾上腺切除术治疗的日本 PA 患者。比较了术前和术后估算肾小球滤过率（eGFR）的变化及 eGFR 分类的分布。此外，还研究了以下肾功能结局的预测因素：（I）eGFR 下降>25%和（II）新出现 eGFR<45ml/min/1.73m。最后，开发并内部验证了两种预测术后肾功能结局的列线图。
6 个月时，eGFR 平均下降 16.7ml/min/1.73m（相应百分比下降：19.7%）。54.6%的患者出现 eGFR 分类升级。年龄、血钾、血浆醛固酮浓度和初始 eGFR 纳入预测术后 eGFR 下降>25%的列线图。高血压持续时间和初始 eGFR 纳入预测新出现 eGFR<45ml/min/1.73m的列线图。每个列线图的受试者工作特征曲线下面积分别为 0.82 和 0.74。
开发了首个可预测 PA 患者术后肾脏结局的列线图。它们将有助于临床医生计算腹腔镜肾上腺切除术后 PA 患者发生肾功能障碍的概率。
