Institute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, M. K. Čiurlionio Str. 21/27, LT-03101 Vilnius, Lithuania.
Center of Urology, Vilnius University Hospital Santaros Klinikos, Santariškių Str. 2, LT-08660 Vilnius, Lithuania.
Medicina (Kaunas). 2022 May 17;58(5):667. doi: 10.3390/medicina58050667.
Background and Objectives: Consequences of partial nephrectomy (PN), intraoperative hypotension (IOH) and postoperative neutrophil to lymphocyte ratio (NLR) may cause postoperative acute kidney injury (AKI) and in long-term-chronic kidney disease (CKD). Our study aimed to identify the AKI incidence after PN, to find clinically significant postoperative AKI and renal dysfunction, and to determine the predictor factors. Materials and Methods: A prospective observational study consisted of 91 patients who received PN with warm ischemia, and estimated preoperative glomerular filtration rate (eGFR) ≥ 60 mL/min and without abnormal albuminuria. Results: 38 (41.8%) patients experienced postoperative AKI. Twenty-one (24.1%) patients had CKD upstage after 1 year follow-up. Sixty-seven percent of CKD upstage patients had AKI 48 h after surgery and 11% after 2 months. All 15 (16.5%) patients with CKD had postoperative AKI. With IOH, OR 1.07, 95% CI 1.03−1.10 and p < 0.001, postoperative NLR after 48 h (OR 1.50, 95% CI 1.19−1.88, p < 0.001) was the major risk factor of AKI. In multivariate logistic regression analysis, the kidney’s resected part volume (OR 1.08, 95% CI 1.03−1.14, p < 0.001) and IOH (OR 1.10, 95% CI 1.04−1.15, p < 0.001) were retained as statistically significant prognostic factors for detecting postoperative renal dysfunction. The independent risk factor for clinically significant postoperative AKI was only IOH (OR, 1.06; p < 0.001). Only AKI with the CKD upstage group has a statistically significant effect (p < 0.0001) on eGFR 6 and 12 months after surgery. Conclusions: The presence of AKI after PN is not rare. IOH and NLR are associated with postoperative AKI. The most important predictive factor of postoperative AKI is an NLR of over 3.5. IOH is an independent risk factor for clinically significant postoperative AKI and together with kidney resected part volume effects postoperative renal dysfunction. Only clinically significant postoperative AKI influences the reduction of postoperative eGFR after 6 and 12 months.
部分肾切除术（PN）、术中低血压（IOH）和术后中性粒细胞与淋巴细胞比值（NLR）的后果可能导致术后急性肾损伤（AKI）和长期慢性肾脏病（CKD）。本研究旨在确定 PN 后 AKI 的发生率，寻找临床显著的术后 AKI 和肾功能障碍，并确定预测因素。
一项前瞻性观察性研究纳入了 91 名接受 PN 治疗且伴有温热缺血、术前估算肾小球滤过率（eGFR）≥60mL/min 且无异常白蛋白尿的患者。
38 名（41.8%）患者术后发生 AKI。21 名（24.1%）患者在 1 年随访时出现 CKD 分期上升。67%的 CKD 分期上升患者在术后 48 小时出现 AKI，11%在术后 2 个月出现 AKI。所有 15 名（16.5%）CKD 患者均发生术后 AKI。伴有 IOH 的患者，OR 为 1.07，95%CI 为 1.03−1.10，p＜0.001，术后 NLR 48 小时（OR 为 1.50，95%CI 为 1.19−1.88，p＜0.001）是 AKI 的主要危险因素。多变量逻辑回归分析显示，肾脏切除部分体积（OR 为 1.08，95%CI 为 1.03−1.14，p＜0.001）和 IOH（OR 为 1.10，95%CI 为 1.04−1.15，p＜0.001）为检测术后肾功能障碍的统计学显著预后因素。只有 IOH 是术后临床显著 AKI 的独立危险因素（OR，1.06；p＜0.001）。只有 AKI 与 CKD 分期上升组术后 6 个月和 12 个月的 eGFR 有统计学显著影响（p＜0.0001）。
PN 后 AKI 的发生并不罕见。IOH 和 NLR 与术后 AKI 相关。术后 AKI 的最重要预测因素是 NLR 超过 3.5。IOH 是术后临床显著 AKI 的独立危险因素，与肾脏切除部分体积一起影响术后肾功能障碍。只有术后临床显著 AKI 会影响术后 6 个月和 12 个月 eGFR 的降低。
