LONG-TERM FOLLOW-UP AFTER PARTIAL REMOVAL OF A SOLITARY KIDNEY
LONG-TERM FOLLOW-UP AFTER PARTIAL REMOVAL OF A SOLITARY KIDNEY
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DOI：
10.1056/nejm199110103251502
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发表时间：
1991-10-10
影响因子：
158.5
通讯作者：
TUBBS, RR
中科院分区：
文献类型：
--
作者：
NOVICK, AC;GEPHARDT, G;TUBBS, RR
背景。 在动物中切除一个以上的肾脏会导致蛋白尿和由于局灶性节段性肾小球硬化而导致的进行性肾衰竭。 这种损伤可能是慢性肾小球高滤过的结果。 本研究的目的是确定肾质量减少 50% 以上对人类残余肾功能和形态的影响。方法。 我们评估了 14 名因肾细胞癌或移行细胞癌接受部分肾切除术的孤立肾患者的长期肾功能。 12、第一个肾脏在 2 个月至 21 年前因相同类型的癌症被切除； 2、另一侧肾脏先天性萎缩。 手术前，没有患者有原发性肾脏疾病的临床或组织病理学证据。 所有 14 名患者均接受了部分肾切除术，以切除局部肿瘤，其中 25% 至 75% 的孤立肾被切除。 他们在手术后 5 至 17 年进行评估（平均 7.7）。结果。 12 例患者术后肾功能稳定，2 例出现终末期肾功能衰竭。 随访期间所有患者的血压均未发生变化。 9 名患者出现蛋白尿，其中 4 名患者出现轻度蛋白尿（每天 0.15 至 0.8 克尿蛋白），5 名患者出现中度至重度蛋白尿（每天 0.9 至 6.7 克）。 蛋白尿的程度与剩余肾组织的量呈负相关（P = 0.0065），并与随访时间直接相关（P = 0.0005）。 4 例中重度蛋白尿患者进行肾活检，结果显示 3 例患者为局灶节段性肾小球硬化，1 例为全球性肾小球硬化。结论。 大多数患者的长期肾功能保持稳定，肾质量减少超过 50%。 然而，这些患者出现蛋白尿、肾小球病和进行性肾衰竭的风险增加。
Background. The removal of more than one kidney in animals leads to proteinuria and progressive renal failure due to focal segmental glomerulosclerosis. This injury may be the result of chronic glomerular hyperfiltration. The purpose of this study was to determine the effect of a reduction in renal mass of more than 50 percent on residual renal function and morphology in humans.Methods. We evaluated long-term renal function in 14 patients with a solitary kidney who had undergone partial nephrectomy for renal-cell or transitional-cell carcinoma. In 12, the first kidney had been removed 2 months to 21 years previously for the same type of cancer; in 2, the other kidney was congenitally atrophic. Before surgery, no patient had clinical or histopathological evidence of primary renal disease. All 14 patients underwent partial nephrectomy to remove a localized tumor, with 25 to 75 percent of the solitary kidney being excised. They were evaluated 5 to 17 years after surgery (mean, 7.7).Results. Twelve patients had stable postoperative renal function, and end-stage renal failure developed in two. There were no changes in blood pressure in any patient during follow-up. Nine patients had proteinuria, which was mild (0.15 to 0.8 g of urinary protein per day) in four and moderate to severe (0.9 to 6.7 g per day) in five. The extent of proteinuria was inversely correlated with the amount of remaining renal tissue (P = 0.0065) and directly correlated with the duration of follow-up (P = 0.0005). Four patients with moderate-to-severe proteinuria had renal biopsies, which revealed focal segmental glomerulosclerosis in three patients and global glomerulosclerosis in one.Conclusions. Long-term renal function remains stable in most patients with a reduction in renal mass of more than 50 percent. These patients are, however, at increased risk for proteinuria, glomerulopathy, and progressive renal failure.