Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are common events after radical nephrectomy (RN). In this study we aimed to predict AKI and CKD after RN relying on specific histological aspects. We collected data from a cohort of 144 patients who underwent radical nephrectomy. A histopathological review of the healthy part of the removed kidney was performed using an established chronicity score (CS). Logistic regression analyses were performed to predict AKI after RN, while linear regression analysis was adopted for estimated glomerular filtration rate (eGFR) variation at 1 year. The outcomes of the study were to determine variables correlated with AKI onset, and with eGFR decay at 1 year. The proportion of AKI was 64%. Logistic analyses showed that baseline eGFR independently predicted AKI (odds ratio 1.04, 95%CI 1.02:1.06). Moreover, AKI (Beta −16, 95%CI −21:−11), baseline eGFR (Beta −0.42, 95%CI −0.52:−0.33), and the presence of arterial narrowing (Beta 10, 95%CI 4:15) were independently associated with eGFR decline. Our findings showed that AKI onset and eGFR decline were more likely to occur with higher baseline eGFR and lower CS, highlighting that RN in normal renal function patients represents a more traumatic event than its CKD counterpart.
Highlights
Acute kidney injury (AKI) and chronic kidney disease (CKD) are two possible sequelae following radical nephrectomy (RN) [1]
The latter, instead, investigated the glomerular filtration rate decline after RN comparing the oncological patients affected by kidney cancer with the living kidney donors (LKDs), elucidating the differences in terms of AKI incidence and CKD development over time [5,6]
One of the most intriguing arguments is that AKI and CKD occurring after surgery should be considered differently in respect to other clinical settings when renal function decline is sharply compromised but not related to an acute loss of nephron mass [7]
Summary
Acute kidney injury (AKI) and chronic kidney disease (CKD) are two possible sequelae following radical nephrectomy (RN) [1]. Post-surgical rates of morbidity and mortality related to kidney imbalance have been thoroughly investigated both from urological and nephrological perspectives [2] The former focused on how surgery (radical vs partial nephrectomy) and technique (cold ischemia vs warm ischemia vs no ischemia) affect renal function, cardiovascular performance, and survival outcomes [3,4]. The latter, instead, investigated the glomerular filtration rate decline after RN comparing the oncological patients affected by kidney cancer with the living kidney donors (LKDs), elucidating the differences in terms of AKI incidence and CKD development over time [5,6].
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