Predictive Preoperative Factors for Renal Insufficiency in Patients Followed for More Than 5 Years After Radical Nephrectomy
Ahn Joong-Seo, 김형준, 전하림, 정병창, 서성일, 이현무, 최한용, 전성수,
소속 상세정보
( Ahn Joong-Seo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
김형준 ( Kim Hyung-Joon )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전하림 ( Jeon Ha-Lim )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
정병창 ( Jeong Byong-Chang )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
서성일 ( Seo Seong-Il )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이현무 ( Lee Hyun-Moo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
최한용 ( Choi Han-Yong )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전성수 ( Jeon Seong-Soo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
KMID : 0358320130540050303
Abstract
Purpose: We assessed the predictive factors for renal insufficiency in patients followed for more than 5 years after radical nephrectomy.
Materials and Methods: Age, gender, history of diabetes, history of hypertension, body mass index, preoperative estimated glomerular filtration rate (eGFR), serum uric acid, urine albumin, normal renal parenchymal volume, tumor size, and ratio of normal parenchymal volume of the removed kidney to that of the remaining kidney were evaluated retrospectively in 89 patients who underwent radical nephrectomy from January 2001 to December 2005. Patients were included whose renal parenchymal volume was measurable by use of perioperative imaging (computed tomography or magnetic resonance imaging), whose preoperative eGFR was greater than 60 mL/min/1.73 m2, and who were followed for more than 5 years. To measure renal parenchymal volume from imaging, we integrated the extent of the normal renal parenchyma from axial slides of images.
Results: In univariate and multivariate binary regression analysis, the parenchymal volume of the remnant kidney (p=0.001), a history of diabetes (p=0.035), and preoperative eGFR (p=0.011) were independent factors for renal insufficiency. By use of a receiver operating characteristic curve, a volume of 170 mL was determined to be an appropriate cutoff value, with sensitivity of 58.7% and specificity of 74.4% for the parenchymal volume of the remnant kidney for predicting eGFR less than 60 mL/min/1.73 m2 (area under the curve, 0.678). The parenchymal volume of the remnant kidney was also an independent factor for the downgrading of the chronic kidney disease category in the multivariate linear regression analysis (p=0.021).
Conclusions: Preoperative eGFR, a history of diabetes, and the radiologic volume of the remaining kidney parenchyma could be useful factors for predicting postoperative renal function. Patients with parenchymal volumes of less than 170 mL have a higher risk of postoperative renal insufficiency, which should be considered carefully when choosing a treatment modality.
키워드
Kidney;Nephrectomy;Organ size;Renal insufficiency
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