Kawamura Naoko, Yokoyama Minato, Tanaka Hajime, Nakayama Takayuki, Yasuda Yosuke, Kijima Toshiki, Yoshida Soichiro, Ishioka Junichiro, Matsuoka Yoh, Saito Kazutaka, Kihara Kazunori, Fujii Yasuhisa
Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Department of Urology, JA Toride Medical Center, Toride, Japan.
Int J Urol. 2019 Jan;26(1):113-118. doi: 10.1111/iju.13799. Epub 2018 Sep 25.
To evaluate the incidence and predictors of acute kidney injury after clampless partial nephrectomy, and its impact on intermediate-term renal function.
The incidence and severity of acute kidney injury were assessed for 262 patients undergoing clampless partial nephrectomy between 2010 and 2015. The association between perioperative covariates and acute kidney injury was evaluated using multivariate logistic regression analysis. An annual change in estimated glomerular filtration rate from 1 year after surgery was calculated according to the presence or absence of acute kidney injury. An impact of acute kidney injury on postoperative renal impairment, defined as a ≥25% estimated glomerular filtration rate decrease, was evaluated.
Overall, 21 (8.0%) patients experienced grade 1 acute kidney injury after clampless partial nephrectomy, and grade ≥2 acute kidney injury was not observed. High tumor complexity was the only independent predictor of acute kidney injury. Estimated glomerular filtration rate in patients with acute kidney injury improved within 1 year, and annual estimated glomerular filtration rate changes were similar among patients with or without acute kidney injury. Ultimately, 13 (5.0%) patients showed postoperative renal impairment during the median follow-up period of 37 months. Advanced age and diabetes mellitus were independent risk factors for renal impairment, but acute kidney injury was not.
The incidence and severity of acute kidney injury after clampless partial nephrectomy are low. Low-grade acute kidney injury after clampless partial nephrectomy does not seem to affect intermediate-term renal function.
评估无阻断肾部分切除术后急性肾损伤的发生率、预测因素及其对中期肾功能的影响。
对2010年至2015年间接受无阻断肾部分切除术的262例患者的急性肾损伤发生率及严重程度进行评估。采用多因素逻辑回归分析评估围手术期协变量与急性肾损伤之间的关联。根据有无急性肾损伤计算术后1年估计肾小球滤过率的年度变化。评估急性肾损伤对术后肾功能损害（定义为估计肾小球滤过率下降≥25%）的影响。
总体而言，21例（8.0%）患者在无阻断肾部分切除术后发生1级急性肾损伤，未观察到≥2级急性肾损伤。肿瘤复杂性高是急性肾损伤的唯一独立预测因素。急性肾损伤患者的估计肾小球滤过率在1年内有所改善，有无急性肾损伤患者的年度估计肾小球滤过率变化相似。最终，在37个月的中位随访期内，13例（5.0%）患者出现术后肾功能损害。高龄和糖尿病是肾功能损害的独立危险因素，但急性肾损伤不是。
无阻断肾部分切除术后急性肾损伤的发生率和严重程度较低。无阻断肾部分切除术后的低级别急性肾损伤似乎不影响中期肾功能。
