Alessandro Antonelli1, Marco Allinovi2, Andrea Cocci3, Giorgio Ivan Russo4, Riccardo Schiavina5, Bernardo Rocco6, Pini Giovannalberto7, Antonio Celia8, Antonio Galfano9, Virginia Varca10, Giorgio Bozzini11, Carlo Ceruti12, Francesco Greco13, Paolo Verze14, Antonio Luigi Pastore15, Angelo Porreca16, Andrea Minervini17. 1. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 2. Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy. 3. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: cocci.andrea@gmail.com. 4. Department of Urology, University of Catania, Catania, Italy. 5. Department of Urology, University of Bolona, Bologna, Italy. 6. Department of Urology, University of Milan, Milan, Italy. 7. Department of Urology, San Raffaele Hospital, Milan, Italy. 8. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. 9. Urology Unit, ASST Niguarda Hospital, Milan, Italy. 10. Department of Urology, G. Salvini Hospital, Milan, Italy. 11. IRCCS Policlinico san Donato, Milan, Italy. 12. Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy. 13. Casa di Cura Dottor Pederzoli, Urology and Minimal Invasive Surgery, Peschiera del Garda, Italy. 14. Department of Urology, University of Naples, Naples, Italy. 15. Urology Unit, "Sapienza" University of Rome, Rome, Italy. 16. Department of Urology, Abano Terme Hospital, Padua, Italy. 17. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Abstract
CONTEXT: Postoperative acute kidney injury (AKI) is a serious complication after kidney surgery, associated with prolonged hospital stay, high morbidity, and mortality. Biomarkers represent a tool of increasing importance to identify renal impairment after partial nephrectomy (PN) or radical nephrectomy (RN) in order to optimize and anticipate the diagnosis of AKI. OBJECTIVE: The goal of this systematic review is to investigate current insights on the role of biomarkers in predicting renal impairment in patients undergoing PN or RN. EVIDENCE ACQUISITION: A systematic review was conducted up to November 30, 2017 through PubMed, Scopus, and Embase databases, to identify eligible studies evaluating the role of biomarkers for the prediction of AKI after PN or RN. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria were applied to select articles. EVIDENCE SYNTHESIS: According to the study selection criteria, 10 publications were included with a total number of 728 patients. Incidence of AKI was 26.7% (range: 9-58%). Based on the evidence reviewed, serum cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) showed a significant correlation with serum creatinine rise postoperatively, emerging as potential noninvasive and early biomarkers of AKI in patients undergoing renal surgery. In this setting, serum cystatin C and urinary NGAL have preceded the rise in serum creatinine peak from 3 up to 24h, even in case of mild renal damage. CONCLUSIONS: The literature underlines the potential usefulness of biomarkers such as cystatin C and NGAL as promising and early tools to predict AKI after PN or RN. However, no strong evidence in support of their use is available to date and further investigations are awaited. PATIENT SUMMARY: We looked at the role of biomarkers in predicting renal injury in patients undergoing partial or radical nephrectomy. Serum cystatin C and urinary neutrophil gelatinase-associated lipocalin have emerged as promising noninvasive, accurate, and early biomarkers.
CONTEXT: Postoperative acute kidney injury (AKI) is a serious complication after kidney surgery, associated with prolonged hospital stay, high morbidity, and mortality. Biomarkers represent a tool of increasing importance to identify renal impairment after partial nephrectomy (PN) or radical nephrectomy (RN) in order to optimize and anticipate the diagnosis of AKI. OBJECTIVE: The goal of this systematic review is to investigate current insights on the role of biomarkers in predicting renal impairment in patients undergoing PN or RN. EVIDENCE ACQUISITION: A systematic review was conducted up to November 30, 2017 through PubMed, Scopus, and Embase databases, to identify eligible studies evaluating the role of biomarkers for the prediction of AKI after PN or RN. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria were applied to select articles. EVIDENCE SYNTHESIS: According to the study selection criteria, 10 publications were included with a total number of 728 patients. Incidence of AKI was 26.7% (range: 9-58%). Based on the evidence reviewed, serum cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) showed a significant correlation with serum creatinine rise postoperatively, emerging as potential noninvasive and early biomarkers of AKI in patients undergoing renal surgery. In this setting, serum cystatin C and urinary NGAL have preceded the rise in serum creatinine peak from 3 up to 24h, even in case of mild renal damage. CONCLUSIONS: The literature underlines the potential usefulness of biomarkers such as cystatin C and NGAL as promising and early tools to predict AKI after PN or RN. However, no strong evidence in support of their use is available to date and further investigations are awaited. PATIENT SUMMARY: We looked at the role of biomarkers in predicting renal injury in patients undergoing partial or radical nephrectomy. Serum cystatin C and urinary neutrophil gelatinase-associated lipocalin have emerged as promising noninvasive, accurate, and early biomarkers.
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