Department of Urology, Shanghai East Hospital, Dalian Medical University, Shanghai, China.
Department of Urology, Changxing People's Hospital of Chongming District, Shanghai, China.
Urol Int. 2022;106(11):1177-1184. doi: 10.1159/000525789. Epub 2022 Aug 9.
This study was conducted to investigate the underlying associations between urine macrophages polarization and renal function recovery after nephron-sparing surgery (NSS) in patients with renal cell carcinoma (RCC) and to explore the potential application values of urine macrophages polarization in predicting the severity of renal ischemia/reperfusion injury (RIRI).
Sixty-two patients with unilateral RCC who underwent NSS in our departments were prospectively recorded and followed up for long-term renal function to assess the onset of acute kidney injury (AKI) and chronic kidney disease (CKD). Urine samples of patients were collected 72 h after surgery for analyzing pro-inflammatory (classically activated/M1) and pro-reparative (alternatively activated/M2) macrophages polarization by flow cytometry. The detailed correlations between urine macrophages polarization and renal function recovery after NSS were explored by statistical analyses.
The cumulative incidence of postoperative AKI was 27.4% (17/62), and 47.0% (8/17) of those eventually developed to CKD during the follow-up. The mean urine M1/M2 ratio was 10.54 ± 8.13 in the AKI group and 3.93 ± 3.10 in the non-AKI group, presenting a significant statistical difference (p < 0.0001). Meanwhile, the urine M1/M2 ratio presented amazing potential in predicting postoperative CKD as well, with a mean ratio of 12.54 ± 9.41 in the CKD group and 4.28 ± 3.21 in the non-CKD group (p < 0.0001). Though univariate analysis implied that urine M1/M2 ratio was a relevant factor of both postoperative AKI and CKD in NSS surgical patients, multivariate analysis did not show satisfying predicting potential in postoperative CKD, mainly due to the very limited candidates enrolled in this study.
Urine macrophages polarization could predict renal function recovery after NSS in patients with RCC. The urine M1/M2 ratio might a potential biomarker of RIRI but needs to be further verified in clinical settings.
本研究旨在探讨肾细胞癌（RCC）患者肾部分切除术后（NSS）尿液巨噬细胞极化与肾功能恢复之间的潜在关联，并探讨尿液巨噬细胞极化在预测肾缺血/再灌注损伤（RIRI）严重程度方面的潜在应用价值。
前瞻性记录并随访了我科 62 例行 NSS 的单侧 RCC 患者的长期肾功能，以评估急性肾损伤（AKI）和慢性肾脏病（CKD）的发生。术后 72 小时收集患者尿液样本，通过流式细胞术分析促炎（经典激活/M1）和修复性（替代激活/M2）巨噬细胞极化。通过统计分析探讨尿液巨噬细胞极化与 NSS 后肾功能恢复的详细相关性。
术后 AKI 的累积发生率为 27.4%（17/62），其中 17 例（47.0%）在随访期间最终发展为 CKD。AKI 组尿 M1/M2 比值为 10.54±8.13，非 AKI 组为 3.93±3.10，差异有统计学意义（p<0.0001）。同时，尿 M1/M2 比值对术后 CKD 也有很好的预测潜力，CKD 组的平均比值为 12.54±9.41，非 CKD 组为 4.28±3.21（p<0.0001）。虽然单因素分析表明，尿 M1/M2 比值是 NSS 术后 AKI 和 CKD 的相关因素，但多因素分析并未显示出在术后 CKD 中有令人满意的预测潜力，主要是由于本研究纳入的患者数量非常有限。
尿液巨噬细胞极化可预测 RCC 患者 NSS 后的肾功能恢复。尿 M1/M2 比值可能是 RIRI 的潜在生物标志物，但需要在临床环境中进一步验证。
