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

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1295-1301
Number of pages7
JournalJournal of Urology
Volume200
Issue number6
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Nephrectomy
Acute Kidney Injury
Kidney
Creatinine
Serum
Glomerular Filtration Rate
Warm Ischemia
Nephrons
Chronic Renal Insufficiency
Sample Size
Ischemia
Regression Analysis
Prospective Studies
Wounds and Injuries
Population

Keywords

  • acute kidney injury
  • chronic
  • ischemia
  • nephrectomy
  • renal insufficiency
  • solitary kidney

ASJC Scopus subject areas

  • Urology

Cite this

Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys : Impact on Long-Term Stability of Renal Function. / Zabell, Joseph; Isharwal, Sudhir; Dong, Wen; Abraham, Joseph; Wu, Jitao; Suk-Ouichai, Chalairat; Palacios, Diego Aguilar; Remer, Erick; Li, Jianbo; Campbell, Steven C.

In: Journal of Urology, Vol. 200, No. 6, 01.12.2018, p. 1295-1301.

Research output: Contribution to journalArticle

Zabell, J, Isharwal, S, Dong, W, Abraham, J, Wu, J, Suk-Ouichai, C, Palacios, DA, Remer, E, Li, J & Campbell, SC 2018, 'Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function', Journal of Urology, vol. 200, no. 6, pp. 1295-1301. https://doi.org/10.1016/j.juro.2018.07.042
Zabell, Joseph ; Isharwal, Sudhir ; Dong, Wen ; Abraham, Joseph ; Wu, Jitao ; Suk-Ouichai, Chalairat ; Palacios, Diego Aguilar ; Remer, Erick ; Li, Jianbo ; Campbell, Steven C. / Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys : Impact on Long-Term Stability of Renal Function. In: Journal of Urology. 2018 ; Vol. 200, No. 6. pp. 1295-1301.
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AU - Abraham, Joseph

AU - Wu, Jitao

AU - Suk-Ouichai, Chalairat

AU - Palacios, Diego Aguilar

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AU - Li, Jianbo

AU - Campbell, Steven C.

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N2 - 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.

AB - 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.

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