Lee Chung Un, Choi Don Kyoung, Chung Jae Hoon, Song Wan, Kang Minyong, Sung Hyun Hwan, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Lee Hyun Moo, Jeon Hwang Gyun
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
Res Rep Urol. 2021 Jun 25;13:407-414. doi: 10.2147/RRU.S317543. eCollection 2021.
We investigated compensatory structural hypertrophy and functional hyperfiltration in patients with renal cell carcinoma (RCC) after radical nephrectomy (RN) according to the presence of proteinuria.
We retrospectively enrolled 471 patients who underwent RN for RCC between October 2005 and December 2013. These patients were divided into two groups according to the presence of postoperative proteinuria (trace or greater (≥1+) urine dipstick). We obtained computed tomography images before and 1 year after surgery to calculate the functional renal volume (FRV). The preoperative and postoperative Chronic Kidney Disease Epidemiology Collaboration equation-calculated glomerular filtration rates (CKD-EPI GFRs) per unit FRV (GFR/FRV) were used to calculate the degree of hyperfiltration.
The mean patient age was 54.7±11.1 years, and the mean preoperative CKD-EPI GFR, FRV, and GFR/FRV were 89.3±13.3 mL/min/1.73 m, 357.2±71.8 cm, and 0.26±0.05 mL/min/1.73 m/cm, respectively. The percentage reduction rate of the GFR was not significantly different according to the presence of proteinuria (normal: -28.5±11.6% vs proteinuria: -28.7±15%; p=0.902); however, the postoperative hypertrophic FRV in the remnant kidney was significantly different (normal: 17.5±9.1% vs proteinuria: 13.8±14.1%; p=0.001). Meanwhile, the change in the percentage rate of the GFR/FRV was not significantly different (normal: 21.1±23% vs proteinuria: 23.8±28.3%; p=0.324). Multivariate logistic regression analysis revealed that age (p=0.010) and the GFR/FRV (p<0.001) were significant predictors of postoperative proteinuria.
Compensatory structural hypertrophy and functional hyperfiltration are positive adaptations that reduce the occurrence of proteinuria.
我们根据蛋白尿的情况，研究了肾细胞癌（RCC）患者在根治性肾切除术（RN）后代偿性结构肥大和功能性超滤过情况。
我们回顾性纳入了2005年10月至2013年12月期间因RCC接受RN的471例患者。根据术后蛋白尿情况（尿试纸检测微量或更高（≥1+））将这些患者分为两组。我们获取了手术前和术后1年的计算机断层扫描图像，以计算功能性肾体积（FRV）。术前和术后使用慢性肾脏病流行病学协作组方程计算的单位FRV肾小球滤过率（CKD-EPI GFRs）（GFR/FRV）来计算超滤过程度。
患者平均年龄为54.7±11.1岁，术前平均CKD-EPI GFR、FRV和GFR/FRV分别为89.3±13.3 mL/min/1.73 m²、357.2±71.8 cm³和0.26±0.05 mL/min/1.73 m²/cm³。根据蛋白尿情况，GFR的降低百分比无显著差异（正常：-28.5±11.6% vs蛋白尿：-28.7±15%；p = 0.902）；然而，残余肾术后肥大的FRV有显著差异（正常：17.5±9.1% vs蛋白尿：13.8±14.1%；p = 0.001）。同时，GFR/FRV的百分比变化无显著差异（正常：21.1±23% vs蛋白尿：23.8±28.3%；p = 0.324）。多因素逻辑回归分析显示，年龄（p = 0.010）和GFR/FRV（p<0.001）是术后蛋白尿的显著预测因素。
代偿性结构肥大和功能性超滤过是减少蛋白尿发生的积极适应性变化。
