Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
Division of Nephrology at University of Naples "Federico II", Naples, Italy.
World J Urol. 2018 Jan;36(1):59-63. doi: 10.1007/s00345-017-2104-7. Epub 2017 Oct 23.
The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term.
This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥ 40% decline in glomerular filtration rate or new-onset severe proteinuria (> 500 mg/24 h). Clinical correlates of acute kidney injury and renal outcome were also examined.
106 patients were enrolled. 52 patients had post-operative acute kidney injury with a median increment of serum creatinine of 0.67 [0.48-0.86] mg/dl; in these patients, serum creatinine and urea increased from the first day post-nephrectomy while contraction of urinary output was found in 7 patients. Older age [OR: 1.72; 95% CI 1.05-2.82; P = 0.030] associated with post-operative acute kidney injury. Over a median follow-up of 8.9 [95% CI 3.1-24.2] years, the combined renal outcome occurred, respectively, in 28 (53.8%) and 14 (25.9%) patients with and without acute kidney injury (P = 0.003). Logistic regression analysis showed that acute kidney injury (OR: 3.22; 95% CI 1.35-7.66; P = 0.008) and male gender (OR: 2.72; 95% CI 1.08-6.85; P = 0.034) were associated with poor renal outcome after adjustment for main comorbidities.
In our population of referred patients, acute kidney injury after unilateral nephrectomy was common and associated with progressive chronic kidney disease, especially in older males.
择期单侧肾切除术后急性肾损伤对肾脏预后的影响尚不清楚。我们评估术后急性肾损伤是否会长期改变肾脏预后。
这是一项回顾性研究，纳入了所有先前接受择期单侧肾切除术的连续成年患者，并转诊至三个肾病科。我们评估了术后急性肾损伤与慢性透析需求、肾小球滤过率下降≥40%或新发生严重蛋白尿（>500mg/24h）的联合肾脏结局之间的关系。还检查了急性肾损伤和肾脏结局的临床相关性。
共纳入 106 例患者。52 例患者术后发生急性肾损伤，血清肌酐中位数升高 0.67[0.48-0.86]mg/dl；这些患者术后第 1 天血清肌酐和尿素升高，7 例患者出现尿量减少。与术后急性肾损伤相关的因素为年龄较大[比值比：1.72；95%置信区间：1.05-2.82；P=0.030]。在中位数为 8.9[95%置信区间：3.1-24.2]年的随访中，分别有 28 例（53.8%）和 14 例（25.9%）患者发生了联合肾脏结局，有无急性肾损伤的患者之间存在差异（P=0.003）。Logistic 回归分析显示，急性肾损伤（比值比：3.22；95%置信区间：1.35-7.66；P=0.008）和男性（比值比：2.72；95%置信区间：1.08-6.85；P=0.034）在调整主要合并症后与肾脏预后不良相关。
在我们的转诊患者人群中，单侧肾切除术后急性肾损伤很常见，与进行性慢性肾脏病有关，尤其是在年龄较大的男性中。
