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Journal of Molecular and Clinical Medicine  2018, Vol. 1 Issue (2): 115-118    DOI: 10.31083/j.jmcm.2018.02.009
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The long-term functional impact of post-operative acute kidney injury in patients undergoing nephron-sparing surgery
Zaher Bahouth1, *(), Yasmine Ghantous2, Edmond Sabo3, Omri Nativ1, Sarel Halachmi1, Boaz Moskovitz1, Zaid Abassi4, Ofer Nativ1
1 Department of Urology, Bnai-Zion Medical Center, Faculty of Medicine, Technion, Haifa 31048, Israel
2 Department of Maxilo-facial surgery, Padeh Medical Center, Tiberias 15208, Israe
3 Department of Pathology, Rambam Medical Institute, Faculty of Medicine, Technion, Haifa 3109601, Israel
4 Department of Physiology, Faculty of Medicine, Technion, Haifa 3109601, Israel
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Abstract  

Nephron-sparing surgery (NSS) is the standard of care for the management of localized renal tumors. A significant number of patients develop acute kidney injury (AKI) following NSS with potential long-term effect on renal function, and eventually overall survival. The aim of the current study was to assess the long-term functional impact of AKI in patients undergoing NSS. From our NSS cohort, we analyzed the clinical and surgical data of patients treated with NSS. Renal function was assessed using serum Creatinine (sCr) and estimated glomerular filtration rate (eGFR) was estimated using the MDRD equation. SCr was assessed daily starting one day before surgery until discharge. AKI was defined using the latest definition by KDIGO (Kidney Disease: Improving Global Outcomes). Appropriate statistical tests were used to compare between both groups. Of 236 patients, 86 (36.4 %) developed AKI. The vast majority of patients ($n=$ 79) displayed grade I AKI, six had grade II and only one patient had grade III. Mean baseline sCr of the AKI group was 1.11 $\pm $ 0.43 mg/dL (median 1.0, range 0.5-3.0), and their long-term mean sCr was 1.4 $\pm$ 0.6 mg/dL (median 1.2, range 0.61-4.5). Median follow-up time was 4 years. Most patients (79 %) of the AKI group showed improvement in renal function compared with the immediate post-operative level. However, eighteen patients (21 %) demonstrated stable or deteriorating renal function. The mean difference between last available sCr and baseline sCr in the improved group was 0.12 mg/dL compared to 0.87 mg/dL in the deteriorating group ($p =$ 0.0001). The only statistically significant difference between patients who improved their sCr and patients who did not, was hypertension at diagnosis ($p =$ 0.02).

Key words:  Acute kidney injury      Nephron-sparing surgery      Renal function      Chronic kidney disease     
Submitted:  04 February 2018      Accepted:  16 February 2018      Published:  20 April 2018     
*Corresponding Author(s):  Zaher Bahouth     E-mail:  Zaher.bahouth@b-zion.org.il

Cite this article: 

Zaher Bahouth, Yasmine Ghantous, Edmond Sabo, Omri Nativ, Sarel Halachmi, Boaz Moskovitz, Zaid Abassi, Ofer Nativ. The long-term functional impact of post-operative acute kidney injury in patients undergoing nephron-sparing surgery. Journal of Molecular and Clinical Medicine, 2018, 1(2): 115-118.

URL: 

https://jmcm.imrpress.com/EN/10.31083/j.jmcm.2018.02.009     OR     https://jmcm.imrpress.com/EN/Y2018/V1/I2/115

Table 1  Baseline characteristics and surgical data of both study groups.
Parameter AKI Non-AKI P-value
(n = 86) (n = 150)
Age (years), mean 士 SD 61.6 士 13.0 60.7 士 11.7 0.5
Sex, no. (%) 0.002
Male 73 (84.9) 99 (66.0)
Female 13 (15.1) 51 (34.0)
Hypertension, no. (%) 56 (65.1) 86 (57.3) 0.3
Smoking, no. (%) 44 (51.1) 87 (58.0) 0.3
Alcohol, no. (%) 31 (36.0) 48 (32.0) 0.5
BMI (kg/m2), mean 士 SD 29.2 士 4.7 28.3 士 4.4 0.2
Tumor size (cm), mean 士 SD 4.3 士 1.8 4.2 士 1.7 0.6
Renal score 8.2 士 1.8 8.0 士 1.8 0.3
Side, no. (%) 0.6
Right 37 (43.0) 60 (40.0)
Left 49 (57.0) 90 (60.0)
Tumor stage, no. (%) 0.6
pT0 5 (5.8) 8 (5.4)
pT1 43 (50.0) 75 (50.0)
pT2 22 (25.5) 44 (29.3)
pT3 9 (10.5) 12(8.0)
N/A 7 (8.1) 11 (7.3)
Tumor histology, no. (%) 0.9
RCC 73 (84.9) 126 (84.0)
Malignant non-RCC 7 (8.7) 13 (8.7)
Benign 3 (3.2) 5 (3.3)
N/A 3 (3.2) 6 (4.0)
Grade, no. (%) 0.3
I 6 (7.0) 14 (9.3)
II 45 (52.4) 78 (52.0)
III 17(19.7) 25 (16.7)
IV 1(1.2) 0 (0)
N/A 17(19.7) 33 (22.0)
Blood transfusion, no. (%) 7 (8.1) 3 (2.0) 0.046
Tumor bed closure, no. (%) 0.004
Sutures 42 (48.8) 41 (27.3)
Glue 40 (46.5) 93 (62.0)
N/A 4 (4.7) 16(10.7)
Operation time (min), mean 士 SD 133 士 38 122 士 34 0.051
Ischemia time (min), mean 士 SD 28.2 士 11 23.7 士 8 0.004
EBL (cc), mean 士 SD 190 士 50 85 士 15 0.047
Follow-up (months) 0.7
mean [range] 47.5 [2-176] 49.4 [2-182]
median 36 37
Table 2  Renal function assessment in the whole cohort and the subgroups.
Parameter All
(n = 236)
All Grades (n = 86) AKI (n = 86)
Grade I (n = 79)
Grades II-III (n = 7) Non-AKI
(n = 150)
P-value
(AKI vs non-AKI)
Baseline sCr Mean 士 SD 1.01 士 0.3 1.1 士 0.4 1.09 士 0.4 1.36 士 0.8 0.96 士 0.2 0.03
Median 0.97 1.0 1.0 1.0 0.95
Baseline eGFR Mean 士 SD 78.5 士 21.1 75.7 士 23.5 76.1 士 22.1 71.2 士 37.7 80.2 士 19.5 0.1
Median 79 77.0 77.0 80.0 80.0
Worst post op sCr Mean 士 SD 1.2 士 0.5 1.6 士 0.6 1.56 士 0.47 2.6 士 0.98 1.03 士 0.3 0.0001
Median 1.1 1.5 1.5 2.4 1.0
Worst post op eGFR Mean 士 SD 64.0+21.1 47.9 士 15 49.8 士 10.9 27.1 士 14.2 73.4 士 18 0.0001
Median 64.0 49.0 50.0 27.9 71.5
Last sCr Mean 士 SD 1.14 士 0.5 1.39 士 0.59 1.37 1.66 1.0 士 0.36 0.0001
Median 1.05 1.2 1.2 1.7 0.95
Last eGFR Mean 士 SD 71.6 士 23.1 60.5 士 23.5 62.1 42.2 77.9 士 20.5 0.0001
Median 72.0 60 61.0 42.0 76.0
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