Evaluation of Renal Function after Partial Nephrectomy and Detection of Clinically Significant Acute Kidney Injury

Jurijus Makevičius; Albertas Čekauskas; Arūnas Želvys; Albertas Ulys; Feliksas Jankevičius; Marius Miglinas

doi:10.3390/medicina58050667

Evaluation of Renal Function after Partial Nephrectomy and Detection of Clinically Significant Acute Kidney Injury

Medicina (Kaunas). 2022 May 17;58(5):667. doi: 10.3390/medicina58050667.

Authors

Jurijus Makevičius^{1

2}, Albertas Čekauskas^{1

2}, Arūnas Želvys^{1

2}, Albertas Ulys³, Feliksas Jankevičius^{1

2}, Marius Miglinas^{1

4}

Affiliations

¹ 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.
² Center of Urology, Vilnius University Hospital Santaros Klinikos, Santariškių Str. 2, LT-08660 Vilnius, Lithuania.
³ Departament of Oncourology, National Cancer Institute, Santariškių Str. 1, LT-08661 Vilnius, Lithuania.
⁴ Center of Nephrology, Vilnius University Hospital Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania.

Abstract

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.

Keywords: acute kidney injury; clinically significant postoperative AKI; intraoperative hypotension; kidney dysfunction; neutrophil to lymphocyte ratio; partial nephrectomy.

Publication types

Observational Study

MeSH terms

Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / etiology
Humans
Hypotension*
Kidney / physiology
Nephrectomy / adverse effects
Renal Insufficiency, Chronic* / complications
Retrospective Studies

Grants and funding

This research received no external funding.