IMR Press / JMCM / Volume 1 / Issue 2 / DOI: 10.31083/j.jmcm.2018.02.009
Open Access Research article
The long-term functional impact of post-operative acute kidney injury in patients undergoing nephron-sparing surgery
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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
* Zaher.bahouth@b-zion.org.il (Zaher Bahouth)
J. Mol. Clin. Med. 2018, 1(2), 115–118; https://doi.org/10.31083/j.jmcm.2018.02.009
Submitted: 4 February 2018 | Accepted: 16 February 2018 | Published: 20 April 2018
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).

Keywords
Acute kidney injury
Nephron-sparing surgery
Renal function
Chronic kidney disease
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