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

Acute kidney injury (AKI) often leads to chronic kidney disease (CKD) in the general population. The long-term functional impact of AKI observed after partial nephrectomy (PN) has not been adequately studied.

From 2004-2014, 90 solitary kidneys managed with PN had necessary studies for analysis including functional data at 4 time points: pre-operative, peak serum creatinine (SCr) post-surgery, new baseline SCr (3-12 months post-operatively), and long-term follow-up SCr (>12 months post-operatively). AKIadjusted was defined by the ratio: observed peak post-operative SCr/projected post-operative SCr (adjusted for parenchymal mass loss to reveal the true effect of ischemia). Long-term change in renal function (long-term functional-change ratio) was defined: most recent GFR/new-baseline GFR. Relationship between grade of AKIadjusted and long-term functional change was assessed by Spearman correlation analysis and multivariable regression.

Median age was 64 and median duration of follow-up was 45 months. Median parenchymal mass preservation was 80%. AKIadjusted occurred in 42% of patients, and was grade 1 in 20 (22%) and grade 2/3 in 18 (20%). On univariable analysis degree of AKIadjusted did not correlate with long-term GFR change (p=0.55). On multivariable analysis, AKIadjusted did not associate with long-term functional change (p>0.05), while presence of diabetes and utilization of warm ischemia associated modestly with long-term functional decline (both p<0.05).

AKI after PN was not a significant or independent predictor of long-term functional decline in our institutional cohort. Prospective study with larger sample sizes and longer follow-up will be required to evaluate factors associated with long-term nephron stability.

The Journal of urology. 2018 Jul 20 [Epub ahead of print]

Joseph Zabell, Sudhir Isharwal, Wen Dong, Joseph Abraham, Jitao Wu, Chalairat Suk-Ouichai, Diego Aguilar Palacios, Erick Remer, Jianbo Li, Steven C Campbell

Department of Urology, University of Minnesota, Minneapolis, MN; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China., Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Radiology, Cleveland Clinic, Cleveland, OH., Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: .

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