دورية أكاديمية
Functional recovery after partial nephrectomy: next generation analysis.
| العنوان: | Functional recovery after partial nephrectomy: next generation analysis. |
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| المؤلفون: | Munoz-Lopez C; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Lewis K; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Attawettayanon W; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.; Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand., Yasuda Y; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.; Tokyo Medical and Dental University, Graduate School, Tokyo, Japan., Emrich Accioly JP; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Rathi N; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Lone Z; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Boumitri M; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Campbell RA; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Wood A; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Kaouk JH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Haber GP; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Eltemamy M; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Krishnamurthi V; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Abouassaly R; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Haywood SC; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Weight CJ; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Campbell SC; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. |
| المصدر: | BJU international [BJU Int] 2023 Aug; Vol. 132 (2), pp. 202-209. Date of Electronic Publication: 2023 Apr 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Blackwell Science Country of Publication: England NLM ID: 100886721 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-410X (Electronic) Linking ISSN: 14644096 NLM ISO Abbreviation: BJU Int Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Oxford, UK : Blackwell Science, c1999- |
| مواضيع طبية MeSH: | Kidney Neoplasms*/pathology, Humans ; Nephrectomy/methods ; Kidney/pathology ; Warm Ischemia/methods ; Ischemia/surgery ; Glomerular Filtration Rate ; Retrospective Studies |
| مستخلص: | Objectives: To provide a more rigorous assessment of factors affecting functional recovery after partial nephrectomy (PN) using novel tools that allow for analysis of more patients and improved accuracy for assessment of parenchymal volume loss, thereby revealing the potential impact of secondary factors such as ischaemia. Patients and Methods: Of 1140 patients managed with PN (2012-2014), 670 (59%) had imaging and serum creatinine levels measured before and after PN necessary for inclusion. Recovery from ischaemia was defined as the ipsilateral glomerular filtration rate (GFR) saved normalised by parenchymal volume saved. Acute kidney injury was assessed through Spectrum Score, which quantifies the degree of acute ipsilateral renal dysfunction due to exposure to ischaemia that would otherwise be masked by the contralateral kidney. Multivariable regression was used to identify predictors of Spectrum Score and Recovery from Ischaemia. Results: In all, 409/189/72 patients had warm/cold/zero ischaemia, respectively, with median (interquartile range [IQR]) ischaemia times for cold and warm ischaemia of 30 (25-42) and 22 (18-28) min, respectively. The median (IQR) global preoperative GFR and new baseline GFR (NBGFR) were 78 (63-92) and 69 (54-81) mL/min/1.73 m 2 , respectively. The median (IQR) ipsilateral preoperative GFR and NBGFR were 40 (33-47) and 31 (24-38) mL/min/1.73 m 2 , respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.83, P < 0.01). The median (IQR) decline in ipsilateral GFR associated with PN was 7.8 (4.5-12) mL/min/1.73 m 2 with loss of parenchyma accounting for 81% of this loss. The median (IQR) recovery from ischaemia was similar across the cold/warm/zero ischaemia groups at 96% (90%-102%), 95% (89%-101%), and 97% (91%-102%), respectively. Independent predictors of Spectrum Score were ischaemia time, tumour complexity, and preoperative global GFR. Independent predictors of recovery from ischaemia were insulin-dependent diabetes mellitus, refractory hypertension, warm ischaemia, and Spectrum Score. Conclusions: The main determinant of functional recovery after PN is parenchymal volume preservation. A more robust and rigorous evaluation allowed us to identify secondary factors including comorbidities, increased tumour complexity, and ischaemia-related factors that are also independently associated with impaired recovery, although altogether these were much less impactful. (© 2023 BJU International.) |
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| فهرسة مساهمة: | Keywords: acute kidney injury; comorbidity; functional recovery; ischaemia; partial nephrectomy |
| تواريخ الأحداث: | Date Created: 20230405 Date Completed: 20231023 Latest Revision: 20231025 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1111/bju.16023 |
| PMID: | 37017637 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1464-410X |
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| DOI: | 10.1111/bju.16023 |