Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy
Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy
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DOI：
10.1111/j.1523-1755.2000.00384.x
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发表时间：
2000-11-01
影响因子：
19.6
通讯作者：
Rodicio, JL
中科院分区：
文献类型：
--
作者：
Praga, M;Hernández, E;Rodicio, JL
背景部分患者在单侧肾切除术后发生蛋白尿和进行性肾功能衰竭，尽管大多数患者保持正常的肾功能。解释这种不同演变的原因尚不清楚。对73例在13.6 +/- 8.6年前接受单侧肾切除术的患者进行了横断面研究。排除了肾切除术时剩余肾脏形态异常、全身性疾病或肾功能异常的患者。所有73例患者在肾切除术时均显示肾功能正常，蛋白尿阴性。回顾患者的医疗记录，并获得整个随访期间的临床和分析数据。在横断面研究中，73例患者中有53例（I组）肾功能正常，蛋白尿阴性。其余20例患者（组II）显示蛋白尿（3.4 +/- 3.1 g/天）。从肾切除到出现蛋白尿的时间为10.1 ± 6.1年。除蛋白尿外，TI组的13名患者还发生了肾功能不全（横断面研究中的血清肌酐为3.9 ± 3.2 mg/ dL）。从出现蛋白尿到出现肾功能不全的时间为4.1 ± 4.3年。大多数患者肾功能不全呈缓慢进展。组I和组II患者在年龄、性别、肾功能或肾切除术时的血压方面无显著差异。相反，TI组患者在肾切除术时的体重指数（BMI）显著高于I组（31.6 +/- 5.6 vs. 24.3 +/- 3.7 kg/m2，P < 0.001），在横断面研究（33.3 +/- 6.6 vs. 25.1 +/- 3.5 kg/m2，P < 0.001）和整个随访期间。在14名肥胖（BMI > 30 kg/m2）患者中，13名（92%）在肾切除术时出现蛋白尿/肾功能不全。相反，在BMI < 30 kg/m2的59例患者中，仅7例（12%）发生这些并发症（P < 0.001）。Kaplan-Meier估计，在接受肾切除术的肥胖患者中，肾切除术后10年蛋白尿阴性和肾功能正常的概率分别为40%和70%。在肾切除术后20年，这些百分比分别为8%和35%。相反，在非肥胖患者中，10年时蛋白尿阴性和肾功能正常的概率分别为93%和98%（P < 0.001），20年时分别为77%和91%（P < 0.001）。多因素Logistic回归分析显示，单侧肾切除术时的BMI与肾脏疾病的发生风险相关（OR = 1.34，CI为1.03 ~ 1.76）。肥胖患者在单侧肾切除术后有发生蛋白尿和慢性肾功能衰竭的风险。建议对这些患者进行定期和长期随访。
Background. Some patients develop proteinuria and progressive renal failure after unilateral nephrectomy, although the majority of patients maintain normal renal function. Reasons to explain this different evolution are not known.Methods. A cross-sectional study was performed in 73 patients who had undergone unilateral nephrectomy 13.6 +/- 8.6 years before. Patients with morphologic abnormalities in the remaining kidney, systemic disorders, or abnormal renal function at the time of nephrectomy were excluded. All of the 73 included patients showed normal renal function and negative proteinuria at nephrectomy. The patient's medical records were reviewed, and clinical and analytical data throughout follow-up were obtained.Results. Fifty-three out of the 73 patients (group I) showed a normal renal function and negative proteinuria at the cross-sectional study. The remaining 20 patients (group II) showed proteinuria (3.4 +/- 3.1 g/day). The time elapsed between ne nephrectomy and proteinuria appearance was 10.1 +/- 6.1 years. Thirteen patients of group TI had developed renal insufficiency (serum creatinine at the cross-sectional study of 3.9 + 3.2 mg/ dL) in addition to proteinuria. The time elapsed between proteinuria appearance and the onset of renal insufficiency was 4.1 +/- 4.3 years. Renal insufficiency showed a slowly progressive course in most of these patients. There were no significant differences between group I and group II patients in age, gender, renal function, or blood pressure at the time of nephrectomy. In contrast, group TI patients showed a body mass index (BMI) that was significantly higher than group I at nephrectomy (31.6 +/- 5.6 vs. 24.3 +/- 3.7 kg/m(2), P < 0.001), at cross-sectional study (33.3 +/- 6.6 vs. 25.1 +/- 3.5 kg/m(2), P < 0.001), and throughout follow-up. Among the 14 obese (BMI > 30 kg/m(2)) patients at the time of nephrectomy, 13 (92%) developed proteinuria/renal insufficiency. In contrast, among the 59 patients with BMI < 30 kg/m(2), only 7 (12%) developed these complications (P < 0.001). Kaplan-Meier estimated probability of negative proteinuria and normal renal function 10 years after nephrectomy was 40 and 70%, respectively, in obese patients at nephrectomy. At 20 years after nephrectomy, these percentages were 8 and 35%, respectively. In contrast, in nonobese patients, the probability of negative proteinuria and normal renal function was 93 and 98%, respectively, at 10 years (P < 0.001) and 77 and 91%, respectively, at 20 years (P < 0.001). Multiple logistic regression analysis showed that the risk of developing renal disease was only statistically correlated with BMI at the time of unilateral nephrectomy (odds ratio 1.34, 1.03 to 1.76 CI).Conclusions. Obese patients are at risk for developing proteinuria and chronic renal failure after unilateral nephrectomy. Regular and long-term follow-up are recommended in these patients.