Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Kocaeli University, Medical School, Kocaeli, Turkey.
Int Braz J Urol. 2019 Sep-Oct;45(5):932-940. doi: 10.1590/S1677-5538.IBJU.2018.0776.
We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN).
We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI.
Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04).
Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.
我们研究了术前蛋白尿与机器人辅助部分肾切除术（RPN）后早期肾功能之间的关系。
我们回顾性分析了 2006 年至 2016 年期间在一家学术中心进行的 1121 例连续 RPN 病例。纳入了无预先存在的慢性肾脏病（CKD）（eGFR≥60 mL/min/1.73m2）且在 RPN 前 1 个月内进行过尿液分析的患者。该队列根据术前是否存在蛋白尿（痕迹或更高（≥1+）尿试纸）进行分类，并比较了各组的临床和功能结局。使用 RIFLE 标准评估急性肾损伤（AKI）的发生率。使用单变量和多变量模型来确定与术后 AKI 相关的因素。
在 947 例患者中，97 例（10.5%）有术前蛋白尿。与术前蛋白尿相关的特征包括非白人种族（p<0.01）、术前糖尿病（p<0.01）和高血压（HTN）（p<0.01）、更高的 ASA（p<0.01）、更高的 BMI（p<0.01）和更高的 Charlson 评分（p<0.01）。有术前蛋白尿的患者 AKI 发生率更高（10.3% vs. 4.6%，p=0.01）。术后一个月内测量的 eGFR 保存值较低（83.6% vs. 91%，p=0.04）；然而，术后 3 个月或最后一次随访时无显著差异。AKI 的独立预测因素是高 BMI（p<0.01）、较长的缺血时间（p<0.01）和术前蛋白尿（p=0.04）。
尿试纸检测到的术前蛋白尿是 RPN 后术后 AKI 的独立预测因素。该检测可能用于识别患者，特别是那些没有明显 CKD 的患者，他们在 RPN 后发生 AKI 的风险增加。
