根治性肾输尿管切除术治疗上尿路上皮癌后急性肾损伤强烈影响肾功能：单中心经验。
Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience.
机构信息
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona; Department of Neuroscience, Imaging and Clinical Science, Physiology and Physiopathology division, "G. D'Annunzio" University, Chieti.
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona.
出版信息
Arch Ital Urol Androl. 2021 Mar 18;93(1):9-14. doi: 10.4081/aiua.2021.1.9.
OBJECTIVE
The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU).
MATERIALS AND METHODS
Between October 2014 and February 2020, 93 patients underwent RNU at our Institution. After considered exclusion criteria, 89 patients were selected. Perioperative clinical factors were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation. We defined AKI as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5-1.9-fold increase in serum creatinine from baseline to I post-operative day (POD). A significant renal function reduction was defined as an eGFR reduction of 40% from baseline at discharge and at last clinical evaluation. Frequency of AKI and eGFR decline was investigated. Association between perioperative clinical factors and AKI and eGFR reduction at discharged and last follow-up was studied using univariate and multivariate models.
RESULTS
AKI was detected at I POD in 45 patients. On multivariate analysis, pre-operative eGFR was an independent predictor of AKI (OR 1.03; p = 0.042). Further, AKI was found to be a significant predictor of eGFR reduction ≥ 40% at discharge at univariate analysis (OR 19.42; p = 0.005) and at multivariate analysis (OR 12.49; p = 0.02). In a multivariate logistic regression model post-operative AKI (OR 5.18; p = 0.033), lack of ipsilateral preoperative hydronephrosis (OR 0.17; p = 0.016), preoperative eGFR (OR 1.04; p = 0.047) and antiplatelet therapy (OR 5.14; p = 0.018) were found to be independent predictors of an eGFR reduction higher than 40% at last clinical evaluation made at a median of 15 (IQR 5-30) months.
CONCLUSIONS
In our cohort, AKI was present in almost 50% of patients after RNU and it was a strong predictor of renal function decline after RNU.
目的
我们的研究旨在调查接受根治性肾输尿管切除术（RNU）的连续上尿路尿路上皮癌（UTUC）患者中术后急性肾损伤（AKI）和肾功能下降的频率及其预测因素。
材料和方法
2014 年 10 月至 2020 年 2 月期间，93 例患者在我院接受了 RNU。考虑排除标准后，选择了 89 例患者。回顾性收集围手术期临床因素。使用慢性肾脏病流行病学合作（CKDEPI）方程计算估计肾小球滤过率（eGFR）。我们将 AKI 定义为血清肌酐增加≥0.3mg/dl 或基线至术后第 1 天（POD1）血清肌酐增加 1.5-1.9 倍。显著的肾功能下降定义为出院时和最后临床评估时 eGFR 较基线下降 40%。研究 AKI 和 eGFR 下降的频率。使用单变量和多变量模型研究围手术期临床因素与出院时和最后随访时 AKI 和 eGFR 下降的关系。
结果
45 例患者在 POD1 时检测到 AKI。多变量分析显示，术前 eGFR 是 AKI 的独立预测因素（OR 1.03；p=0.042）。此外，在单变量分析中，AKI 被发现是出院时 eGFR 下降≥40%的显著预测因素（OR 19.42；p=0.005）和多变量分析（OR 12.49；p=0.02）。在多变量逻辑回归模型中，术后 AKI（OR 5.18；p=0.033）、术前无同侧肾积水（OR 0.17；p=0.016）、术前 eGFR（OR 1.04；p=0.047）和抗血小板治疗（OR 5.14；p=0.018）被发现是最后临床评估时 eGFR 下降超过 40%的独立预测因素，最后临床评估在中位数为 15（IQR 5-30）个月时进行。
结论
在我们的队列中，RNU 后几乎 50%的患者出现 AKI，它是 RNU 后肾功能下降的强有力预测因素。
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