Analysis of risk factors for acute kidney injury after radical nephrectomy

Huang Jiaqi; Xu Peirong; Zhang Sihong; Hu Xiaoyi; Jiang Shuai; Zhu Yanjun; Guo Jianming; Wang Hang

doi:10.3760/cma.j.cn112330-20191209-00543

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• 临床研究 •

根治性肾切除术后发生急性肾功能不全的危险因素分析

中华泌尿外科杂志, 2020,41(03) : 175-178. DOI: 10.3760/cma.j.cn112330-20191209-00543

摘要

目的

探讨根治性肾切除术后患者发生急性肾功能不全(AKI)的危险因素。

方法

回顾性分析2013年2月至2017年9月因肾细胞癌于复旦大学附属中山医院行根治性肾切除术的920例患者的临床资料，男612例，女308例。中位年龄60(20～75)岁。伴高血压病313例(34.0%)，糖尿病132例(14.3%)。有吸烟史111例(12.1%)。术前肾功能分期1～2期829例(90.1%)，3～5期91例(9.9%)。术前血红蛋白低于正常值下限391例(42.5%)，白细胞计数升高66例(7.2%)，血小板计数升高72例(7.8%)。白蛋白低于正常值下限65例(7.1%)，乳酸脱氢酶升高73例(7.9%)。尿素氮升高48例(5.2%)，尿酸升高123例(13.4%)，尿蛋白阳性88例(9.7%)。所有患者均行根治性肾切除术，其中开放手术496例(53.9%)，腹腔镜手术424例(46.1%)。随访患者术后48 h内血肌酐变化情况。根据KDIGO标准定义AKI，采用logistic回归分析患者术后发生2～3期AKI的危险因素。

结果

本组920例患者住院期间发生1～3期AKI分别为627例(68.2%)、42例(4.6%)和10例(1.1%)。单因素分析结果显示糖尿病(OR＝2.34，P＝0.01)、尿蛋白阳性(OR＝2.22，P＝0.04)、白细胞计数升高(OR＝2.54，P＝0.02)与术后发生2～3期AKI显著相关，多因素logistic回归分析结果显示糖尿病(OR＝2.51，P＝0.01)和白细胞计数升高(OR＝2.69，P＝0.02)为术后发生2～3期AKI的独立危险因素。

结论

患有糖尿病及术前白细胞计数升高的肾癌患者行根治性肾切除术后更容易发生2～3期AKI。

引用本文: 黄嘉琦, 许培榕, 张思弘, 等. 根治性肾切除术后发生急性肾功能不全的危险因素分析 [J] . 中华泌尿外科杂志,2020,41 (03): 175-178. DOI: 10.3760/cma.j.cn112330-20191209-00543

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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肾细胞癌的发病率逐年升高，目前手术是局限性肾癌的主要治疗手段^[1]。既往根治性肾切除术是治疗局限性肾癌的金标准^[2]，随着外科技术的提升及对肾功能保护的重视，肾部分切除术已广泛应用^[3]。但考虑到肿瘤位置、大小、术者自身经验、技能和器械设备条件等限制因素，对于多数T₂期及部分T₁期肾癌，根治性手术难以避免^[4,5]。然而，根治性肾切除术是造成术后慢性肾脏病(chronic kidney disease, CKD)的重要危险因素^[6]。

贡献者信息

黄嘉琦

复旦大学附属中山医院泌尿外科，上海　200032

许培榕

复旦大学附属中山医院泌尿外科，上海　200032

张思弘

复旦大学附属中山医院泌尿外科，上海　200032

胡骁轶

复旦大学附属中山医院泌尿外科，上海　200032

姜帅

复旦大学附属中山医院泌尿外科，上海　200032

朱延军

复旦大学附属中山医院泌尿外科，上海　200032

郭剑明

复旦大学附属中山医院泌尿外科，上海　200032

王杭

复旦大学附属中山医院泌尿外科，上海　200032

通信作者

王杭

复旦大学附属中山医院泌尿外科，上海　200032

Email：wang.hang@zs-hospital.sh.cn

关键词

癌，肾细胞; 肾切除术; 急性肾功能不全;

基金项目

上海市卫生健康委先进适宜技术推广项目（2019SY073）

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2020-03-15

收稿日期：2019-12-09

本文编辑

黄鹿

Clinical Original Article

Analysis of risk factors for acute kidney injury after radical nephrectomy

Huang Jiaqi, Xu Peirong, Zhang Sihong, Hu Xiaoyi, Jiang Shuai, Zhu Yanjun, Guo Jianming, Wang Hang

Published 2020-03-15

Cite as Chin J Urol, 2020,41(03): 175-178. DOI: 10.3760/cma.j.cn112330-20191209-00543

Abstract

Objective

To explore the risk factors of acute kidney injury(AKI) in patients after radical nephrectomy.

Methods

We retrospectively collected clinical information of 920 patients with renal cell carcinoma who underwent radical nephrectomy at Zhongshan Hospital, Fudan University from February 2013 to September 2017. There were 612 male and 308 female patients included in this study, with a median age of 60 (range from 20-75 years). 313 patients (34.0%) had hypertension, 132 patients (14.3%) had diabetes, and 111 patients (12.1%) had smoking history. 829 cases (90.1%) were in stage 1-2 for preoperative renal function staging, and 91 cases (9.9%) were in stage 3-5. Preoperative hemoglobin was lower than the lower limit of normal in 391 cases (42.5%), white blood cell count increased in 66 cases (7.2%), and platelet increased in 72 cases (7.8%). Albumin was lower than the lower limit of normal in 65 cases (7.1%), lactate dehydrogenase increased in 73 cases (7.9%). blood urea nitrogen increased in 48 cases (5.2%), uric acid increased in 123 cases (13.4%), and urinary protein was positive in 88 cases (9.7%). 496 cases (53.9%) underwent open surgery and 424 (46.1%) underwent laparoscopic surgery. The changes in serum creatinine were followed up within 48 hours after surgery. AKI was defined according to the KDIGO standard. Logistic regression was used to analyze the risk factors for postoperative stage 2-3 AKI in patients.

Results

Stage 1-3 AKI occurred on 627, 42 and 10 patients during hospitalization, respectively. Univariate analysis showed that diabetes (OR=2.34, P=0.01), positive urine protein (OR=2.22, P=0.04), and elevated white blood cell count (OR=2.54, P=0.02) were significantly associated with postoperative stage 2-3 AKI. Multivariate logistic regression analysis showed that diabetes (OR=2.51, P=0.01) and elevated white blood cell count (OR=2.69, P=0.02) were independent risk factors for postoperative stage 2-3 AKI.

Conclusion

Renal cell carcinoma patients with diabetes or preoperative elevated white blood cell count are more likely to develop stage 2-3 AKI after radical nephrectomy.

Key words:

Carcinoma, renal cell; Nephrectomy; Acute kidney injury

Contributor Information

Huang Jiaqi