Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function

© 2018 American Urological Association Education and Research, Inc. Purpose: Acute kidney injury often leads to chronic kidney disease in the general population. The long-term functional impact of acute kidney injury observed after partial nephrectomy has not been adequately studied. Materials and M...

Full description

Saved in:
Bibliographic Details
Main Authors: Joseph Zabell, Sudhir Isharwal, Wen Dong, Joseph Abraham, Jitao Wu, Chalairat Suk-Ouichai, Diego Aguilar Palacios, Erick Remer, Jianbo Li, Steven C. Campbell
Other Authors: Yantai Yuhuangding Hospital
Format: Article
Published: 2019
Subjects:
Online Access:https://repository.li.mahidol.ac.th/handle/123456789/46164
Tags: Add Tag
No Tags, Be the first to tag this record!
Institution: Mahidol University
id th-mahidol.46164
record_format dspace
spelling th-mahidol.461642019-08-23T18:34:37Z Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function Joseph Zabell Sudhir Isharwal Wen Dong Joseph Abraham Jitao Wu Chalairat Suk-Ouichai Diego Aguilar Palacios Erick Remer Jianbo Li Steven C. Campbell Yantai Yuhuangding Hospital Cleveland Clinic Lerner College of Medicine of Case Western Reserve University University of Minnesota Twin Cities Sun Yat-Sen University Cleveland Clinic Foundation Faculty of Medicine, Siriraj Hospital, Mahidol University Medicine © 2018 American Urological Association Education and Research, Inc. Purpose: Acute kidney injury often leads to chronic kidney disease in the general population. The long-term functional impact of acute kidney injury observed after partial nephrectomy has not been adequately studied. Materials and Methods: From 2004 to 2014 necessary studies for analysis were available for 90 solitary kidneys managed by partial nephrectomy. Functional data at 4 time points included preoperative serum creatinine, peak postoperative serum creatinine, new baseline serum creatinine 3 to 12 months postoperatively and long-term followup serum creatinine more than 12 months postoperatively. Adjusted acute kidney injury was defined by the ratio, observed peak postoperative serum creatinine/projected postoperative serum creatinine adjusted for parenchymal mass loss to reveal the true effect of ischemia. The long-term change in renal function (the long-term functional change ratio) was defined as the most recent glomerular filtration rate/the new baseline glomerular filtration rate. The relationship between the grade of the adjusted acute kidney injury and the long-term functional change was assessed by Spearman correlation analysis and multivariable regression. Results: Median patient age was 64 years and median followup was 45 months. Median parenchymal mass preservation was 80%. Adjusted acute kidney injury occurred in 42% of patients, including grade 1 injury in 20 (22%) and grade 2/3 in 18 (20%). On univariable analysis the degree of the adjusted acute kidney injury did not correlate with the long-term glomerular filtration rate change (p = 0.55). On multivariable analysis adjusted acute kidney injury was not associated with a long-term functional change (p >0.05) while diabetes and warm ischemia were modestly associated with a long-term functional decline (each p <0.05). Conclusions: Acute kidney injury after partial nephrectomy was not a significant or independent predictor of long-term functional decline in our institutional cohort. A prospective study with larger sample sizes and longer followup is required to evaluate factors associated with long-term nephron stability. 2019-08-23T11:34:37Z 2019-08-23T11:34:37Z 2018-12-01 Article Journal of Urology. Vol.200, No.6 (2018), 1295-1301 10.1016/j.juro.2018.07.042 15273792 00225347 2-s2.0-85055027158 https://repository.li.mahidol.ac.th/handle/123456789/46164 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055027158&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Joseph Zabell
Sudhir Isharwal
Wen Dong
Joseph Abraham
Jitao Wu
Chalairat Suk-Ouichai
Diego Aguilar Palacios
Erick Remer
Jianbo Li
Steven C. Campbell
Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
description © 2018 American Urological Association Education and Research, Inc. Purpose: Acute kidney injury often leads to chronic kidney disease in the general population. The long-term functional impact of acute kidney injury observed after partial nephrectomy has not been adequately studied. Materials and Methods: From 2004 to 2014 necessary studies for analysis were available for 90 solitary kidneys managed by partial nephrectomy. Functional data at 4 time points included preoperative serum creatinine, peak postoperative serum creatinine, new baseline serum creatinine 3 to 12 months postoperatively and long-term followup serum creatinine more than 12 months postoperatively. Adjusted acute kidney injury was defined by the ratio, observed peak postoperative serum creatinine/projected postoperative serum creatinine adjusted for parenchymal mass loss to reveal the true effect of ischemia. The long-term change in renal function (the long-term functional change ratio) was defined as the most recent glomerular filtration rate/the new baseline glomerular filtration rate. The relationship between the grade of the adjusted acute kidney injury and the long-term functional change was assessed by Spearman correlation analysis and multivariable regression. Results: Median patient age was 64 years and median followup was 45 months. Median parenchymal mass preservation was 80%. Adjusted acute kidney injury occurred in 42% of patients, including grade 1 injury in 20 (22%) and grade 2/3 in 18 (20%). On univariable analysis the degree of the adjusted acute kidney injury did not correlate with the long-term glomerular filtration rate change (p = 0.55). On multivariable analysis adjusted acute kidney injury was not associated with a long-term functional change (p >0.05) while diabetes and warm ischemia were modestly associated with a long-term functional decline (each p <0.05). Conclusions: Acute kidney injury after partial nephrectomy was not a significant or independent predictor of long-term functional decline in our institutional cohort. A prospective study with larger sample sizes and longer followup is required to evaluate factors associated with long-term nephron stability.
author2 Yantai Yuhuangding Hospital
author_facet Yantai Yuhuangding Hospital
Joseph Zabell
Sudhir Isharwal
Wen Dong
Joseph Abraham
Jitao Wu
Chalairat Suk-Ouichai
Diego Aguilar Palacios
Erick Remer
Jianbo Li
Steven C. Campbell
format Article
author Joseph Zabell
Sudhir Isharwal
Wen Dong
Joseph Abraham
Jitao Wu
Chalairat Suk-Ouichai
Diego Aguilar Palacios
Erick Remer
Jianbo Li
Steven C. Campbell
author_sort Joseph Zabell
title Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
title_short Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
title_full Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
title_fullStr Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
title_full_unstemmed Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function
title_sort acute kidney injury after partial nephrectomy of solitary kidneys: impact on long-term stability of renal function
publishDate 2019
url https://repository.li.mahidol.ac.th/handle/123456789/46164
_version_ 1763493482583818240