Carlo Garofalo1, Maria Elena Liberti2, Domenico Russo3, Luigi Russo3, Giorgio Fuiano4, Paola Cianfrone4, Giuseppe Conte2, Luca De Nicola2, Roberto Minutolo2, Silvio Borrelli2. 1. Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy. carlo.garofalo@hotmail.it. 2. Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy. 3. Division of Nephrology at University of Naples "Federico II", Naples, Italy. 4. Division of Nephrology at University of Catanzaro "Magna Graecia", Catanzaro, Italy.
Abstract
PURPOSE: The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term. METHODS: This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥ 40% decline in glomerular filtration rate or new-onset severe proteinuria (> 500 mg/24 h). Clinical correlates of acute kidney injury and renal outcome were also examined. RESULTS: 106 patients were enrolled. 52 patients had post-operative acute kidney injury with a median increment of serum creatinine of 0.67 [0.48-0.86] mg/dl; in these patients, serum creatinine and urea increased from the first day post-nephrectomy while contraction of urinary output was found in 7 patients. Older age [OR: 1.72; 95% CI 1.05-2.82; P = 0.030] associated with post-operative acute kidney injury. Over a median follow-up of 8.9 [95% CI 3.1-24.2] years, the combined renal outcome occurred, respectively, in 28 (53.8%) and 14 (25.9%) patients with and without acute kidney injury (P = 0.003). Logistic regression analysis showed that acute kidney injury (OR: 3.22; 95% CI 1.35-7.66; P = 0.008) and male gender (OR: 2.72; 95% CI 1.08-6.85; P = 0.034) were associated with poor renal outcome after adjustment for main comorbidities. CONCLUSIONS: In our population of referred patients, acute kidney injury after unilateral nephrectomy was common and associated with progressive chronic kidney disease, especially in older males.
PURPOSE: The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term. METHODS: This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥ 40% decline in glomerular filtration rate or new-onset severe proteinuria (> 500 mg/24 h). Clinical correlates of acute kidney injury and renal outcome were also examined. RESULTS: 106 patients were enrolled. 52 patients had post-operative acute kidney injury with a median increment of serum creatinine of 0.67 [0.48-0.86] mg/dl; in these patients, serum creatinine and urea increased from the first day post-nephrectomy while contraction of urinary output was found in 7 patients. Older age [OR: 1.72; 95% CI 1.05-2.82; P = 0.030] associated with post-operative acute kidney injury. Over a median follow-up of 8.9 [95% CI 3.1-24.2] years, the combined renal outcome occurred, respectively, in 28 (53.8%) and 14 (25.9%) patients with and without acute kidney injury (P = 0.003). Logistic regression analysis showed that acute kidney injury (OR: 3.22; 95% CI 1.35-7.66; P = 0.008) and male gender (OR: 2.72; 95% CI 1.08-6.85; P = 0.034) were associated with poor renal outcome after adjustment for main comorbidities. CONCLUSIONS: In our population of referred patients, acute kidney injury after unilateral nephrectomy was common and associated with progressive chronic kidney disease, especially in older males.
Authors: Ann M O'Hare; Adam Batten; Nilka Ríos Burrows; Meda E Pavkov; Leslie Taylor; Indra Gupta; Jeff Todd-Stenberg; Charles Maynard; Rudolph A Rodriguez; Fliss E M Murtagh; Eric B Larson; Desmond E Williams Journal: Am J Kidney Dis Date: 2012-02-04 Impact factor: 8.860
Authors: Glenn M Chertow; Elisabeth Burdick; Melissa Honour; Joseph V Bonventre; David W Bates Journal: J Am Soc Nephrol Date: 2005-09-21 Impact factor: 10.121
Authors: Andrea Lassnigg; Daniel Schmidlin; Mohamed Mouhieddine; Lucas M Bachmann; Wilfred Druml; Peter Bauer; Michael Hiesmayr Journal: J Am Soc Nephrol Date: 2004-06 Impact factor: 10.121
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Simon Sawhney; Angharad Marks; Nick Fluck; Adeera Levin; David McLernon; Gordon Prescott; Corri Black Journal: Kidney Int Date: 2017-04-14 Impact factor: 10.612
Authors: Florence L Johnson; Nimesh S A Patel; Gareth S D Purvis; Fausto Chiazza; Jianmin Chen; Regina Sordi; Guillaume Hache; Viktoria V Merezhko; Massimo Collino; Muhammed M Yaqoob; Christoph Thiemermann Journal: J Am Heart Assoc Date: 2017-07-03 Impact factor: 5.501