Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Urol Oncol. 2021 Mar;39(3):196.e15-196.e20. doi: 10.1016/j.urolonc.2020.11.007. Epub 2020 Dec 9.
To define how much of renal function was determined by the preserved renal parenchymal volume and the ischemic insult during partial nephrectomy (PN) long after surgery.
We analyzed the data of 530 consecutive patients who had undergone PN. For all patients, renal function was measured preoperatively and again at 3 postoperative months, then annually using Tc-diethylenetriaminepentaacetic acid renal scan. Perioperative variables potentially affecting the long-term ipsilateral glomerular filtration rate (GFR) and their time-varying contribution were assessed using a linear mixed model.
The mean preoperative ipsilateral GFR was 42.9 ml/min, which decreased by 27.3% at 3 months but began to recover thereafter continuing until 4 years (Δ% GFR at 1, 2, 3, 4, and 5 years: 22.3%, 18.5%, 14.7%, 10.0%, and 9.6%, respectively). Parenchymal volume reduction and ischemic time were significantly associated with postoperative ipsilateral GFR throughout observation period unvarying with time. Diabetes and proteinuria were not significant determinants of ipsilateral function at 3 months but became significant at 5 years. In multivariate analysis regarding recovery slope, volume reduction (β = -0.026, SE 0.006, P < 0.0001), preoperative ipsilateral GFR (β = -0.021, SE 0.007, P = 0.0012), proteinuria (β = -0.942, SE 0.372, P = 0.0116), and diabetes (β = -0.396, SE 0.197, P = 0.0447) were independently significant.
Ipsilateral renal function continued to improve until 5 years after PN. Parenchymal volume loss was the major determinant and its impact on long-term ipsilateral renal function remained constant while ischemic time affected early GFR reduction with its impact diminishing over time. Patient-related factors including diabetes and proteinuria gained significance over time and became independent determinants of recovery slope.
定义部分肾切除术 (PN) 后很长时间内，保留的肾实质体积和缺血损伤对肾功能的影响程度。
我们分析了 530 例连续接受 PN 的患者的数据。所有患者均在术前和术后 3 个月使用 Tc-二乙三胺五乙酸肾扫描进行术前和术后 3 个月的肾功能测量，然后每年测量一次。使用线性混合模型评估可能影响长期同侧肾小球滤过率 (GFR) 的围手术期变量及其随时间的变化贡献。
平均术前同侧 GFR 为 42.9 ml/min，术后 3 个月下降 27.3%，但此后开始恢复，直至 4 年（Δ%GFR 在 1、2、3、4 和 5 年时分别为 22.3%、18.5%、14.7%、10.0%和 9.6%）。实质体积减少和缺血时间与整个观察期内术后同侧 GFR 显著相关，且不受时间影响。糖尿病和蛋白尿在术后 3 个月时不是同侧功能的显著决定因素，但在 5 年后成为显著决定因素。在关于恢复斜率的多变量分析中，体积减少 (β = -0.026，SE 0.006，P < 0.0001)、术前同侧 GFR (β = -0.021，SE 0.007，P = 0.0012)、蛋白尿 (β = -0.942，SE 0.372，P = 0.0116) 和糖尿病 (β = -0.396，SE 0.197，P = 0.0447) 是独立的显著因素。
PN 后同侧肾功能持续改善，直至 5 年。实质体积丢失是主要决定因素，其对长期同侧肾功能的影响保持不变，而缺血时间影响早期 GFR 下降，其影响随时间逐渐减弱。包括糖尿病和蛋白尿在内的患者相关因素随时间推移变得重要，并成为恢复斜率的独立决定因素。
