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Predictors for postoperative renal function after open partial nephrectomy: Including postoperative biomarkers
Author(s) -
Takagi Toshio,
Kondo Tsunenori,
Iizuka Junpei,
Tomita Eri,
Kobayashi Hirohito,
Hashimoto Yasunobu,
Tanabe Kazunari
Publication year - 2012
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2012.03037.x
Subject(s) - medicine , renal function , nephrectomy , urology , kidney , kidney disease , univariate analysis , acute kidney injury , multivariate analysis
Objectives: To assess the predictors of postoperative renal insufficiency after open partial nephrectomy. Methods: A total of 195 patients who underwent open partial nephrectomy were the participants in this study. Patients with a decrease in the estimated glomerular filtration rate of >25% from baseline were evaluated on the basis of multiple factors including patient‐specific, surgical, tumor and postoperative factors. Postoperative estimated glomerular filtration rate data were recorded between 3 and 6 months after surgery. Results: Of the 195 patients, 18 (9%) had a decrease in estimated glomerular filtration rate of >25%. Percentage of preserved renal parenchyma ( P = 0.0078), nearness of tumor to renal sinus ( P = 0.0108), location of tumor to middle part of kidney ( P = 0.0112), postoperative highest lactase dehydrogenase ( P < 0.0001), postoperative body temperature ( P = 0.0314) and postoperative acute kidney injury ( P < 0.0001) were significantly different between patients with a decrease in estimated glomerular filtration rate of >25% and those with a decrease in estimated glomerular filtration rate ≤25% on univariate analysis. Multivariate analysis showed that postoperative highest lactase dehydrogenase ( P = 0.0408) and acute kidney injury ( P = 0.0002) were independent predictors for decrease of estimated glomerular filtration rate >25%. In contrast, patient characteristic factors (chronic kidney disease stage), surgical factors (clamping time and PPRP) and tumor factors (radius, endophytic/exophytic, nearness and location component) were not significant predictors. Conclusions: Postoperative factors, lactase dehydrogenase and acute kidney injury, were strong predictors for renal insufficiency after open partial nephrectomy. Thus, a strict follow up is advisable in patients showing high postoperative levels of these two biomarkers.