Objectives: To assess the predictors of postoperative renal insufficiency after open partial nephrectomy.
Methods: A total of 195 patients who underwent open partial nephrectomy were the participants in this study. Patients with a decrease in the estimated glomerular filtration rate of >25% from baseline were evaluated on the basis of multiple factors including patient-specific, surgical, tumor and postoperative factors. Postoperative estimated glomerular filtration rate data were recorded between 3 and 6 months after surgery.
Results: Of the 195 patients, 18 (9%) had a decrease in estimated glomerular filtration rate of >25%. Percentage of preserved renal parenchyma (P = 0.0078), nearness of tumor to renal sinus (P = 0.0108), location of tumor to middle part of kidney (P = 0.0112), postoperative highest lactase dehydrogenase (P < 0.0001), postoperative body temperature (P = 0.0314) and postoperative acute kidney injury (P < 0.0001) were significantly different between patients with a decrease in estimated glomerular filtration rate of >25% and those with a decrease in estimated glomerular filtration rate ≤25% on univariate analysis. Multivariate analysis showed that postoperative highest lactase dehydrogenase (P = 0.0408) and acute kidney injury (P = 0.0002) were independent predictors for decrease of estimated glomerular filtration rate >25%. In contrast, patient characteristic factors (chronic kidney disease stage), surgical factors (clamping time and PPRP) and tumor factors (radius, endophytic/exophytic, nearness and location component) were not significant predictors.
Conclusions: Postoperative factors, lactase dehydrogenase and acute kidney injury, were strong predictors for renal insufficiency after open partial nephrectomy. Thus, a strict follow up is advisable in patients showing high postoperative levels of these two biomarkers.
© 2012 The Japanese Urological Association.