Dawidek Mark T, Chan Ernest, Boyle Shawna L, Sener Alp, Luke Patrick P
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Surgery, London Health Sciences Center, London, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Surgery, London Health Sciences Center, London, ON, Canada.
Urology. 2018 Feb;112:98-102. doi: 10.1016/j.urology.2017.10.004. Epub 2017 Oct 16.
To assess renal function in the operated kidney at different time points post partial nephrectomy (PN) and establish the time in which optimal recovery occurs. Recovery of renal function post-PN has received significant attention. However, the optimal time to determine full recovery has not been clearly established.
Renal function following minimally invasive (laparoscopic and robotic) PNs performed between 2002 and 2015 was reviewed. Patients included in this study had renal function assessed preoperatively as well as 3 days, 6-12 weeks, and 1 year post-PN, using a combination of estimated glomerular filtration rate (eGFR) from serum creatinine and relative renal uptake (RRU) from Tc99m-MAG3 renal scintigraphy. Together, eGFR and RRU provide the ipsilateral renal function (IRF) of the operated organ.
At 6-12 weeks postoperatively, percent preserved eGFR, RRU, and IRF (relative to preoperative baselines) were 92.1%, 83.3%, and 77.4% respectively. %IRF at 6-12 weeks was significantly improved from %IRF at 3 days postoperatively, but did not differ significantly from 1 year postoperatively. Furthermore, 89% of patients had RRU values at 6-12 weeks which differed by less than 5% from RRU values at 1 year.
Our data suggest that renal function recovery at 6-12 weeks was equivalent to long-term recovery at 1 year in the majority of post-PN patients. This has important implications for post-PN follow-up, particularly in assessing the functional outcomes utilizing novel minimally invasive PN strategies, as well as in planning staged procedures for bilateral synchronous renal masses.
评估部分肾切除术（PN）后不同时间点手术侧肾脏的肾功能，并确定最佳恢复时间。PN术后肾功能的恢复受到了广泛关注。然而，确定完全恢复的最佳时间尚未明确。
回顾了2002年至2015年间进行的微创（腹腔镜和机器人辅助）PN术后的肾功能情况。本研究纳入的患者术前以及PN术后3天、6 - 12周和1年进行了肾功能评估，采用血清肌酐估算的肾小球滤过率（eGFR）和锝99m - 巯基乙酰三甘氨酸（Tc99m - MAG3）肾动态显像的相对肾摄取（RRU）相结合的方法。eGFR和RRU共同提供手术器官的同侧肾功能（IRF）。
术后6 - 12周时，保留的eGFR、RRU和IRF（相对于术前基线）百分比分别为92.1%、83.3%和77.4%。术后6 - 12周的%IRF较术后3天有显著改善，但与术后1年相比无显著差异。此外，89%的患者术后6 - 12周的RRU值与术后1年的RRU值相差不到5%。
我们的数据表明，在大多数PN术后患者中，6 - 12周时的肾功能恢复与1年时的长期恢复相当。这对PN术后随访具有重要意义，特别是在利用新型微创PN策略评估功能结局以及规划双侧同步肾肿块的分期手术方面。
