Preoperative CT volumetry of estimated residual kidney for prediction of postoperative chronic kidney disease in patients with renal cell carcinoma
Preoperative CT volumetry of estimated residual kidney for prediction of postoperative chronic kidney disease in patients with renal cell carcinoma
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DOI：
10.1007/s10157-020-01984-8
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发表时间：
2020-10-30
影响因子：
2.3
通讯作者：
Takahashi, Satoru
中科院分区：
文献类型：
--
作者：
Hori, Yutaro;Obinata, Daisuke;Takahashi, Satoru
背景肾细胞癌的外科治疗会在一定程度上缩小肾脏体积，并可能导致术后慢性肾脏疾病。我们用CT体积计法制作了一种新的术后肾功能指标。为了确定包括这一标志物在内的各种参数的影响，我们观察了有经验的病例手术前后的肾功能。方法2004~2014年间，对181例肾癌患者行全肾或部分肾切除术。本研究纳入138例术前CT容积测量病例。我们评估了用于评估围术期和术后肾功能的参数，包括年龄、性别、血肌酐、EGFR、所进行的手术、病理、估计的残余肾体积和相关疾病。在手术前、术后即刻和术后5年评估有无急性肾损伤(AKI)和慢性肾脏疾病(CKD)。结果多因素Logistic回归分析显示，AKI、术前EGFR和残余肾体积是影响术后CKD预后的重要因素。此外，这些因素中三项阳性的患者术后CKD的发生率比其中一项或两项阳性的患者更显著。结论利用这些预测因素，可以确定CKD的高危患者是否需要早期肾脏保护治疗。
Background Surgical treatments for renal cell carcinoma reduces kidney volume to some degree and may derive postsurgical chronic kidney disease. We made a new marker for postoperative renal function using CT volumetry. To determine the impact of various parameters including this marker, we observed pre- and postsurgical renal function of experienced cases. Methods From 2004 to 2014, we underwent total or partial nephrectomy for 181 patients with renal carcinoma in a single institution. Of the total, 138 cases with presurgical CT volumetry were included in this study. We evaluated parameters for assessments of peri- and postoperative renal function including age, gender, serum creatinine, eGFR, performed surgery, pathology, estimated residual kidney volume and associated disease. Presence or absence of acute kidney injury (AKI) and chronic kidney disease (CKD) were also evaluated before, immediately after and 5 years after surgery. Results Multiple logistic regression analysis identified AKI, preoperative eGFR and estimated residual kidney volume as significant prognostic factors for the postoperative CKD. Moreover, cases with triple positive of these factors suffer postoperative CKD more significantly than those with one or two positives. Conclusion Using these predictive factors, we may determine patients with high risk for CKD who require an early intervention of renal protective treatment.