Preoperative Glomerular Filtration Rate Research Articles

Risk factors of renal function deterioration after radical nephroureterectomy for upper tract urothelial carcinoma.

To investigate the risk factors of renal function deterioration after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). A total of 153 patients with UTUC who underwent radical surgery at a high-volume center in China from January 2015 to December 2019 were included in this study. The renal function of all patients was evaluated during follow-up. Besides, these patients were grouped according to postoperative renal function. The risk factors of renal function deterioration included age, sex, body mass index (BMI), T stage, tumor location and size, lymph node invasion, lymph node dissection (LND), surgical margin, tumor histology, lymphovascular invasion (LVI), hypertension, diabetes, hematuria, blood transfusion, hydronephrosis on the affected side, urine specific gravity, creatinine, uric acid, and preoperative glomerular filtration rate (GFR) on the healthy and affected sides. The correlation between risk factors and inclusion indexes was analyzed using univariate and multivariate analyses. A total of 153 patients were enrolled in this study, and the follow-up continued for 14 (11, 24) months. Acute kidney injury (AKI) was diagnosed in 65 patients in the short-term follow-up after RNU, and renal function deterioration was diagnosed in 52 patients in the long-term follow-up after RNU. The univariate analysis of 65 patients with short-term AKI revealed that there were statistically significant differences in preoperative hydronephrosis, hypertension, urinary protein, tumor size, preoperative Hb, preoperative creatinine, blood transfusion, and preoperative GFR of the healthy kidney. The multivariate Logistic regression analysis results showed that preoperative creatinine, GFR of the healthy kidney, and blood transfusion were independent risk factors for AKI. Moreover, The multivariate Logistic regression analysis of 52 patients with long-term renal insufficiency after surgery indicated that there were statistically significant differences in preoperative hydronephrosis, tumor size, preoperative GFR of the healthy kidney, and postoperative AKI. For patients with UTUC, the preoperative creatinine level is high, blood transfusion was given during or after procedure and the GFR of the healthy kidney is low, it is easy to have AKI in the short term after operation. In addition, there was no hydronephrosis before operation, the tumor size was small, the GFR of the healthy kidney was low before operation, AKI occurred after operation, the renal function was easy to deteriorate for a long time after operation. The above risk factors may aggravate renal function deterioration of these patients after surgery, resulting in the loss of the opportunity to continue treatment.

Functional recovery after partial nephrectomy in a solitary kidney

ObjectivesPartial nephrectomy (PN) is the reference standard for renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain poorly defined. Patients/MethodsSingle center, retrospective analysis of 841 RMSK patients (1975–2022) managed with PN with functional data, including 361/435/45 with cold/warm/zero ischemia, respectively. A total of 155 of these patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery-from-ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Logistic regression identified predictive factors for AKI and predictors of Rec-Ischemia were analyzed by multivariable linear regression. ResultsOverall, median preoperative GFR was 56.7 ml/min/1.73m2 and new-baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, a primary focus of this study, median warm (n = 70)/cold (n = 85) ischemia times were 25/34 minutes, respectively; and median preoperative, new-baseline and 5-year GFRs were 57.8, 45.0, and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.84, p < 0.001). Parenchymal volume loss accounted for 69% of the total median GFR decline associated with PN, leaving only 3 to 4 ml/min/1.73m2 attributed to ischemia and other factors. AKI occurred in 52% of patients and the only independent predictor of AKI was ischemia time. Independent predictors of reduced Rec-Ischemia were increased age, warm ischemia, and AKI. ConclusionThe main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type/duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required.

Risk of acute kidney injury in elective percutaneous coronary intervention: A comparative study of radial and femoral access

The impact of vascular access type, specifically transradial versus transfemoral, on the occurrence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. In this study, we aimed to compare the incidence of AKI between the two access groups.&#x0D; Methods. This prospective observational study involved 164 adult patients undergoing elective PCI. Patients were categorized into transfemoral (n = 100) and transradial (n = 64) groups. Demographic data, including age, sex, body surface area, and preoperative glomerular filtration rate, as well as clinical information such as the presence of baseline ventricular dysfunction, diabetes mellitus, hypertension, postoperative blood loss, and transfusion volume, were recorded. Serum creatinine levels within the first 48-72 hours postoperatively were also documented.&#x0D; Results. Out of 100 patients in the transfemoral group, 12 (12%) developed AKI compared with 2 patients out of 64 (3.13%) in the transradial group. In the logistic multivariate analysis, several independent risk factors for AKI in patients undergoing PCI were identified. These factors included age &gt;55 years (OR 2.88, 95% CI 1.09; 11.97, p = 0.046), diabetes (OR 4.82, 95% CI 1.12; 31.65, p = 0.039), preprocedural creatinine levels &gt; 0.85 mg/dL (OR 3.17, 95% CI 1.54; 17.96, p = 0.019), fluoroscopy time &gt; 10 min (OR 6.55, 95% CI 1.65; 26.03, p = 0.008), Mehran score indicating a risk of contrast-induced nephropathy &gt;8 (OR 4.23, 95% CI 1.25; 14.3, p = 0.020), and transfemoral access (OR 3.22, 95% CI 1.08; 18.54, p = 0.044).&#x0D; Conclusions. Transradial access is associated with a significant independent reduction in the incidence of post-PCI AKI compared with transfemoral access. Age &gt;55 years, diabetes, preprocedural creatinine &gt; 0.85 mg/dL, fluoroscopy time &gt; 10 min, Mehran score &gt;8, and transfemoral access were identified as independent risk factors for AKI in patients undergoing PCI.

Correlation between bilateral GFR in patients with localized renal cancer after partial nephrectomy.

To explore the relationship between the residual glomerular filtration rate (GFR) on the operated side and the GFR on the contralateral side following partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC). Following institutional review board approval, we conducted a retrospective analysis of clinical records from May 2018 to July 2023, involving 118 patients who underwent partial nephrectomy for unilateral localized kidney tumors (T1-T2). Glomerular filtration rate data were assessed using single photon emission computed tomography (SPECT)/computed tomography imaging [using 9mTc-DTPA (diethylenetriaminepentaacetic acid) renal dynamic imaging]. The independent determinants of postoperative renal function or renal function change were determined using linear regression analysis. In addition, the patient's demographic, clinical, and nephrometry characteristics were collected. A total of 58 patients were finally enrolled. The preoperative and postoperative GFR of bilateral kidneys showed a significant positive correlation. Postoperative GFR of the operated kidney was the independent predictor of GFR of contralateral kidney (p = 0.001). Tumor diameter (p = 0.036), age (p = 0.005), and postoperative GFR of the contralateral kidney (p = 0.001) were all independent predictors of postoperative GFR of the operated kidney. ΔGFR1 was the independent predictor of ΔGFR2. Results showed that a more pronounced postoperative decline in GFR on the operated side corresponded to a weaker compensatory capacity of the contralateral-side kidney. During the course of the surgical procedure, the active endeavor to safeguard the renal function of the operated kidney side holds paramount importance, which yields positive outcomes for postoperative kidney function on the contralateral side, consequently contributing to the overall preservation of renal function.

Parenchymal volume analysis to assess longitudinal functional decline following partial nephrectomy.

To identify factors associated with longitudinal ipsilateral functional decline after partial nephrectomy (PN). Of 1140 patients managed with PN (2012-2014), 349 (31%) had imaging/serum creatinine levels pre-PN, 1-12 months post-PN (new baseline), and >3 years later necessary for inclusion. Parenchymal-volume analysis was used to determine split renal function. Patients were grouped as having significant renal comorbidity (CohortSRC : diabetes mellitus with insulin-dependence or end-organ damage, refractory hypertension, or severe pre-existing chronic kidney disease) vs not having significant renal comorbidity (CohortNoSRC ) preoperatively. Multivariable regression was used to identify predictors of annual ipsilateral parenchymal atrophy and functional decline relative to new baseline values post-PN, after the kidney had healed. The median follow-up was 6.3 years with 87/226/36 patients having cold/warm/zero ischaemia. The median cold/warm ischaemia times were 32/22 min. Overall, the median tumour size was 3.0 cm. The preoperative glomerular filtration rate (GFR) and new baseline GFR (NBGFR) were 81 and 71 mL/min/1.73 m2 , respectively. After establishment of the NBGFR, the median loss of global and ipsilateral function was 0.7 and 0.4 mL/min/1.73 m2 /year, respectively, consistent with the natural ageing process. Overall, the median ipsilateral parenchymal atrophy was 1.2 cm3 /year and accounted for a median of 53% of the annual functional decline. Significant renal comorbidity, age, and warm ischaemia were independently associated with ipsilateral parenchymal atrophy (all P < 0.01). Significant renal comorbidity and ipsilateral parenchymal atrophy were independently associated with annual ipsilateral functional decline (both P < 0.01). Annual median ipsilateral parenchymal atrophy and functional decline were both significantly increased for CohortSRC compared to CohortNoSRC (2.8 vs 0.9 cm3 , P < 0.01 and 0.90 vs 0.30 mL/min/1.73 m2 /year, P < 0.01, respectively). Longitudinal renal function following PN generally follows the normal ageing process. Significant renal comorbidities, age, warm ischaemia, and ipsilateral parenchymal atrophy were the most important predictors of ipsilateral functional decline following establishment of NBGFR.

Renal Artery Reimplantation Versus Bypass in Elective Open Aneurysm Repair

Complex open abdominal aortic aneurysm (AAA) repair often necessitates revascularization of renal arteries by either renal artery reimplantation or bypass. This study aims to evaluate the perioperative and short term outcomes between these two strategies of renal artery revascularization. We performed a retrospective review of patients who underwent open AAA repair from 2004-2020 at our own institution. Patients who underwent elective suprarenal, juxtarenal, or type 4 thoracoabdominal aneurysm repair were identified using current procedural terminology (CPT) codes as well as a retrospectively maintained database of AAA patients. Patients who had symptomatic aneurysm or significant renal artery stenosis prior to AAA repair were excluded. Patient demographics, intraoperative conditions, renal function, bypass patency and perioperative and postoperative outcome at 30 days and 1 year were compared. 143 patients underwent either renal artery reimplantation (n=86) or bypass (n=57) during this time period. The mean age was 69.7 years and 76.2% of the patients were male. Median preoperative creatinine was 1.2 mg/dL for the renal bypass group vs 1.06 mg/dL for reimplantation (P=0.088). Both groups had similar median preoperative glomerular filtration rate (GFR) of >60 mL/min (P=0.13). Bypass and reimplantation groups had similar perioperative complications including acute kidney injury (51.8% vs 49.4% P=0.78), inpatient dialysis (3.6% vs 1.2% P=0.56), myocardial infarction (1.8% vs 2.4% P=0.99), and death (3.5% vs 4.7% P=0.99), respectively. During the 30 day follow-up period, renal artery stenosis was identified in 9.8% of bypasses and 6.7% of reimplantations (P=0.71). 6.1% of patients in the bypass group had renal failure requiring dialysis (both acute and permanent) compared to 1.3% in reimplantation group (P=0.3). For those who had 1 year follow up, the reimplantation group had higher new incidence of renal artery stenosis compared to bypass group (6 vs. 0 p=0.16). Given that there is no significant difference in outcomes between renal artery reimplantation and bypass within 30 days or at 1 year follow-up, both bypass and re-implantation are acceptable means for renal artery revascularization during elective AAA repair.

METAL LEVELS AND GLOMERULAR FILTRATION RATE AFTER BIRMINGHAM HIP RESURFACING

When the Birmingham Hip Resurfacing (BHR) metal-on-metal implant system was approved by the United States Food and Drug Administration in 2006, a multicenter, prospective, post-approval study (PAS) was required. This study uses data from the PAS to investigate metal level and glomerular filtration rate (GFR) trends over the first decade in vivo.Between October 2006 and March 2011, 290 primary BHR procedures were performed among 262 patients at 5 sites. Whole blood samples were sent to a single specialized laboratory to determine GFR, cobalt (Co) and chromium (Cr) levels. The population for this study consists of 117 unrevised unilateral patients with a mean age at surgery of 51.3±6.5 years who had pre-operative, 1-year, 4-year, 5-year and 10-year laboratory data. The mean follow-up for these patients that included 36 females was 10.1±0.2 years.Median metal levels at 1-year increased relative to pre-operative values for Co (by a factor of 9.7 from 0.13 to 1.26 ppb, p&lt;0.001) and Cr (by a factor of 2.5 from 0. 60 to 1.50 ppb, p&lt;0.001). Metal levels subsequently remained relatively constant over time with a median 10-year value of 1.12 ppb for Co and 1.29 ppb for Cr. Based on 585 blood samples from all 117 patients, there was no relationship between GFR and Co (→=−0.06, p=0.14) or Cr (→=0.05, p=0.27) levels. However, lower pre-operative GFR values were associated with larger increases in Co at 1-year relative to the pre-operative level (→=−0.26, p=0.005). There was no relationship between pre-operative GFR values and changes in Cr at 1 year (→=−0.13, p=0.15).Through the first decade in vivo, elevated whole blood metal levels for unilateral BHR patients do not appear to adversely affect GFR. However, patients with lower pre-operative GFR values tend to have larger increases in their Co level at 1-year.

Functional recovery after partial nephrectomy: next generation analysis.

To provide a more rigorous assessment of factors affecting functional recovery after partial nephrectomy (PN) using novel tools that allow for analysis of more patients and improved accuracy for assessment of parenchymal volume loss, thereby revealing the potential impact of secondary factors such as ischaemia. Of 1140 patients managed with PN (2012-2014), 670 (59%) had imaging and serum creatinine levels measured before and after PN necessary for inclusion. Recovery from ischaemia was defined as the ipsilateral glomerular filtration rate (GFR) saved normalised by parenchymal volume saved. Acute kidney injury was assessed through Spectrum Score, which quantifies the degree of acute ipsilateral renal dysfunction due to exposure to ischaemia that would otherwise be masked by the contralateral kidney. Multivariable regression was used to identify predictors of Spectrum Score and Recovery from Ischaemia. In all, 409/189/72 patients had warm/cold/zero ischaemia, respectively, with median (interquartile range [IQR]) ischaemia times for cold and warm ischaemia of 30 (25-42) and 22 (18-28) min, respectively. The median (IQR) global preoperative GFR and new baseline GFR (NBGFR) were 78 (63-92) and 69 (54-81) mL/min/1.73 m2 , respectively. The median (IQR) ipsilateral preoperative GFR and NBGFR were 40 (33-47) and 31 (24-38) mL/min/1.73 m2 , respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.83, P < 0.01). The median (IQR) decline in ipsilateral GFR associated with PN was 7.8 (4.5-12) mL/min/1.73 m2 with loss of parenchyma accounting for 81% of this loss. The median (IQR) recovery from ischaemia was similar across the cold/warm/zero ischaemia groups at 96% (90%-102%), 95% (89%-101%), and 97% (91%-102%), respectively. Independent predictors of Spectrum Score were ischaemia time, tumour complexity, and preoperative global GFR. Independent predictors of recovery from ischaemia were insulin-dependent diabetes mellitus, refractory hypertension, warm ischaemia, and Spectrum Score. The main determinant of functional recovery after PN is parenchymal volume preservation. A more robust and rigorous evaluation allowed us to identify secondary factors including comorbidities, increased tumour complexity, and ischaemia-related factors that are also independently associated with impaired recovery, although altogether these were much less impactful.

Choroidal Vascularity Index and Choroidal Thickness Changes Following Renal Transplantation.

This study aimed to evaluate changes in subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), estimated glomerular filtration rate (GFR), mean arterial pressure (MAP), and intraocular pressure (IOP) after renal transplantation. A total of 49 renal transplantation patients were included in this prospective study. CVI and SFCT on enhanced-depth imaging optic coherence tomography (EDI-OCT), MAP at the cubital fossa, GFR, and IOP were measured preoperatively and at postoperative 1 week and 1 month. In the analysis of EDI-OCT images, luminal area (LA) and stromal area of the choroid were determined using the image binarization method. CVI was defined as the ratio of LA to total choroid area. The effects of GFR, IOP, and MAP on CVI and SFCT were investigated. The study included 23 women (47%) and 26 men (53%) with a mean age of 26.28±8.25 years (range: 18-52). Changes between preoperative, postoperative 1-week, and postoperative 1-month GFR values, CVI, and SFCT measurements were evaluated. There were significant differences between preoperative and postoperative GFR and SFCT measurements (p<0.001), but no significant differences between preoperative and postoperative CVI (p=0.09), MAP (p=0.14), or IOP (p=0.84) measurements. The present study demonstrated that SFCT increased significantly with GFR, while there was no change in CVI values.

PD43-03 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY

You have accessJournal of UrologyCME1 Apr 2023PD43-03 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Worapat Attawettayanon, Yosuke Yasuda, JJ Zhang, Nityam Rathi, Carlos Munoz-Lopez, Kieran Lewis, Ben Ponvilawan, Snehi Sha, Jianbo Li, Joao Accioly, Rebecca Campbell, Joseph Zabell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Christopher Weight, and Steven Campbell Worapat AttawettayanonWorapat Attawettayanon More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , JJ ZhangJJ Zhang More articles by this author , Nityam RathiNityam Rathi More articles by this author , Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Kieran LewisKieran Lewis More articles by this author , Ben PonvilawanBen Ponvilawan More articles by this author , Snehi ShaSnehi Sha More articles by this author , Jianbo LiJianbo Li More articles by this author , Joao AcciolyJoao Accioly More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Joseph ZabellJoseph Zabell More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Mohamad EltemamyMohamad Eltemamy More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Christopher WeightChristopher Weight More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the reference standard for management of renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain ill-defined. METHODS: 841 RMSK patients (1975-2022) managed with PN with functional data were identified, including 361/435/45 with cold/warm/zero ischemia, respectively. 155 patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery from ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Multivariable analysis was utilized to identify predictive factors for AKI and Rec-Ischemia. RESULTS: Overall, median preoperative GFR was 56.7ml/min/1.73m2 and median new baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, median warm (n=70)/cold(n=85) ischemia times were 25/34 minutes, respectively, and median preoperative, new baseline and 5-year GFRs were 57.8, 45.0 and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r=0.84, p<0.001). Loss of parenchymal volume accounted for 69% of the total median GFR decline associated with PN, leaving only an average of 3-4 ml/min/1.73m2 due to ischemia and other factors. AKI occurred in 52% of patients and was Grade 2/3 in 20%. The only independent predictor of AKI was ischemia time, and independent predictors of Rec-Ischemia were age, warm ischemia, and AKI grade. CONCLUSIONS: The main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type and duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of vascularized parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1118 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Worapat Attawettayanon More articles by this author Yosuke Yasuda More articles by this author JJ Zhang More articles by this author Nityam Rathi More articles by this author Carlos Munoz-Lopez More articles by this author Kieran Lewis More articles by this author Ben Ponvilawan More articles by this author Snehi Sha More articles by this author Jianbo Li More articles by this author Joao Accioly More articles by this author Rebecca Campbell More articles by this author Joseph Zabell More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Mohamad Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Christopher Weight More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation between kidney function and mortality in pyogenic spondylodiscitis: the glomerular filtration rate (GFR) as new predictive parameter?

ObjectivePyogenic spondylodiscitis is a severe medical condition, often requiring surgical intervention. Numerous risk factors are known, such as obesity, neurological impairment and old age. In-hospital mortality remains high, therefore other factors may be contributing to the increased mortality. To evaluate kidney function as a risk factor for increased morbidity of pyogenic spondylodiscitis, the glomerular filtration rate (GFR) was correlated with the patients' clinical course.Materials and methodsWe retrospectively reviewed the cases of 366 patients and 255 were included for analysis. Clinical, laboratory and surgical data were recorded with a minimum follow-up of three months. For clinical outcome measurement, mortality, length of stay and perioperative complications were analysed.ResultsThe study included 255 patients (173 men, 82 women; mean age 66.3 years). Patients with a GFR < 59 mL/min spent an average of 5 days longer in the hospital than those with a GFR ≥ 60 mL/min (p = 0.071). The mortality rate increased significantly with a decrease in GFR: A GFR of 30–59 mL/min had a mortality rate of 17.6%, whereas a GFR of < 29 mL/min had one of 30.4% (p = 0.003). Patients with impaired GFR showed an increased rate of postoperative complications (OR 4.7 p = 0.002) and higher rate of intensive care unit (ICU) stay (OR 8.7 p = < 0.001).DiscussionPreoperative GFR values showed a significant correlation with in-hospital mortality in patients with spondylodiscitis, when graded according to the KDIGO stages. Furthermore, a GFR of < 29 ml/mL contributes to a longer ICU stay, postoperative complications and a longer total hospital stay. Therefore, the preoperative GFR could be a marker of kidney function and as a valuable predictive risk factor regarding the clinical in-hospital course of patients suffering from pyogenic spondylodiscitis.

Accuracy of fully automated, AI-generated models compared with validated clinical model to predict post-operative glomerular filtration rate after renal surgery.

693 Background: The American Urologic Association (AUA) recommends estimation of the postoperative glomerular filtration rate (GFR) in patients with a renal mass to help decide between partial nephrectomy (PN) or radical nephrectomy (RN). If postoperative GFR&lt;45 mL/min/1.73m2, a PN should be prioritized. Most existing methods to predict postoperative GFR are rarely implemented in the clinical setting due to complexity. Previously validated models based on clinical equations or kidney volumes from hand-segmented or semi-automated segmentations are quite accurate but have seen limited uptake in clinical practice. We hypothesize that we could develop an artificial intelligence (AI)-GFR prediction that would be calculated automatically on a preoperative computed tomography (CT) scan and predict a postoperative GFR as accurately as a validated clinical model. Methods: 300 patients undergoing PN or RN for renal tumor from the 2021Kidney and Kidney Tumor Segmentation Challenge(KiTS21) were analyzed. We excluded 7 patients having bilateral tumors. Preoperative GFR was the closest recorded value preoperatively and postoperative GFR≥90 days postoperatively. Split-renal-function (SRF) was determined in a fully automated way from preoperative imaging and our previously developed deep learning segmentation model. We programmed the algorithm to estimate postoperative GFR as 1.24×preoperative GFR×contralateral SRF for RN; and as 89% of the preoperative GFR for PN. We compared AI-predicted GFR to a validated clinical model (GFR=35+preoperative GFR(x0.65)-18(if radical nephrectomy)-age(x0.25)+3(if tumor size &gt;7 cm)-2 (if diabetes)). We compared the AI and clinical model estimations of GFR to the measured postoperative GFR using correlation coefficients (R) and compared the ability of AI models to predict a postoperative GFR&lt;45 using logistic regression and AUCs. Results: In 293 patients, the median age was 60 years ((IQR) 51-68), 40.6% were female, and 62.1% had PN. The median tumor size was 4.2 (2.6-6.1), and 91.8% of the tumors were malignant, of which 35.1% were high-grade, 25.6% were high-stage, and 21.8% had necrosis. The median R.E.N.A.L. nephrometry score was 8 (7-9). When comparing measured postoperative GFR, the correlation coefficients were 0.75 and 0.77 for the AI model and clinical models, respectively. For the prediction of a postoperative GFR&lt; 45 ml/min/1.73m2, the AI and clinical models performed similarly (AUC of 0.89 and 0.9, respectively). Conclusions: Our study demonstrates the feasibility of a fully automated prediction of postoperative GFR based on CT imaging and baseline GFR with comparable predictive accuracy to existing validated clinical prediction models. These AI-generated predictions can be implemented for decision-making, with no clinical details, clinician time, or measurements needed.

Association of cardiopulmonary bypass with acute kidney injury in patients undergoing coronary artery bypass grafting: a retrospective cohort study.

Association of cardiopulmonary bypass with acute kidney injury in patients undergoing coronary artery bypass grafting: a retrospective cohort study.

Temperature management of intraoperative cardiopulmonary bypass in valve replacement surgery: a retrospective analysis of the impact on postoperative organ function.

This study aimed to systematically analyze the effects of cardiopulmonary bypass (CPB) at different temperatures on the function of different organs in patients after heart valve replacement and to investigate its safety and feasibility. The data of 275 heart valve replacement surgery patients who underwent static suction compound anesthesia under CPB between February 2018 and October 2019 were retrospectively analyzed and divided into normothermic CPB anesthesia group (group 0), shallow hypothermic CPB anesthesia group (group 1), medium hypothermic CPB anesthesia group (group 2), and deep hypothermic CPB anesthesia group (group 3) according to the different intraoperative CPB temperatures. The basic preoperative conditions, cardiac resuscitation, number of defibrillations, postoperative ICU stay, postoperative hospital stay, and postoperative evaluation of different organ functions, such as heart, lung, and kidney functions, were analyzed and studied in each group. The comparison of preoperative and postoperative pulmonary artery pressure and left ventricular internal diameter (LVD) was statistically significant in each group (p < 0.05), and the postoperative pulmonary function pressure was statistically significant in group 0 compared with groups 1 and 2 (p < 0.05). The preoperative glomerular filtration rate (eGFR) and the eGFR on the first postoperative day were statistically significant in all the groups (p < 0.05), and the eGFR on the first postoperative day in groups 1 and 2 were statistically significant (p < 0.05). The control of appropriate temperature during CPB was associated with the recovery of organ function in patients after valve replacement. Intravenous compound general anesthesia with superficial hypothermic CPB might be more beneficial in recovering cardiac, pulmonary, and renal functions.

Effect of decreased renal function on poor oncological outcome after radical cystectomy.

To evaluate the impact of preoperative renal impairment on the oncological outcomes of patients with urothelial carcinoma who underwent radical cystectomy. We retrospectively reviewed the medical records of patients with urothelial carcinoma who underwent radical cystectomy from 2004 to 2017. All patients who underwent preoperative 99mTc-diethylenetriaminepentaacetic acid renal scintigraphy (DTPA) were identified. We divided the patients into two groups according to their glomerular filtration rates (GFRs): GFR group 1, GFR≥90 mL/min/1.73 m²; GFR group 2, 60≤GFR<90 mL/min/1.73 m². We included 89 patients in GFR group 1 and 246 patients in GFR group 2 and compared the clinicopathological characteristics and oncological outcomes between the two groups. The mean time required for recurrence was 125.5±8.0 months in GFR group 1 and 85.7±7.4 months in GFR group 2 (p=0.030). The mean cancer-specific survival was 131.7±7.8 months in GFR group 1 and 95.5±6.9 months in GFR group 2 (p=0.051). The mean overall survival was 123.3±8.1 months in GFR group 1 and 79.5±6.6 months in GFR group 2 (p=0.004). Preoperative GFR values in the range of 60≤GFR<90 mL/min/1.73 m² are independent prognostic factors for poor recurrence-free survival, cancer-specific survival, and overall survival in patients after radical cystectomy compared with GFR values of ≥90 mL/min/1.73 m².

Risk Factors of Chronic Kidney Disease after Partial Nephrectomy

Background: In comparison with radical nephrectomy, partial nephrectomy (PN) is considered a better option for small renal mass surgery, because of optimal kidney tissue removal and parenchyma preservation. But there are patients with worsening postoperative renal function (RF) and chronic kidney disease (CKD) after PN. Therefore, the study aimed to evaluate and detect risk factors for CKD after PN.Materials and Methods. A prospective observational study was conducted, which consisted of 91 individuals who received PN with warm ischemia and an estimated preoperative glomerular filtration rate (eGFR) ≥ 60 ml/min/1.72m2 without pathologic albuminuria. Preoperative and intraoperative factors like intraoperative hypotension (IOH), blood loss, and resected part volume were analyzed.Results. At 6-month follow-up, 14 (15.4 %) patients experienced postoperative CKD. After 12 months of follow-up, 15 (16.5 %) patients had CKD. Patients with CKD had a lower preoperative eGFR than non-CKD group (69.0 vs 91.0 ml/min/1.72m2, p &lt; 0.001), longer ischemia (20.0 vs 14.0, p = 0.002) and IOH time (40.0 (40.0; 47.5) vs 0.0 (0.0; 26.2) min, p &lt; 0.001). Also, higher volumes of resected kidney part tumor and removed parenchyma with higher glomerulosclerosis amounts (73.3 % vs 14.5 %, p = 0.009) were found in CKD group. Estimated blood loss &gt; 500 ml during PN was discovered to be the major risk factor for CKD development (OR 11.13, 95 % CI 1.88–65.92, p = 0.008). Furthermore, kidney resected part volume (OR 1.05, 95% CI 1.05-1.10, p = 0.033) and IOH time (OR 1.11, 95% CI 1.03-1.19, p = 0.005) were identified as risk factors for postoperative CKD. Conclusions. Patients after PN are at an increased risk of CKD development. Most commonly, postoperative CKD occurs in the first 6 months after PN and appears stable after 12 months of follow-up. Blood loss &gt; 500 ml during PN, IOH and resected kidney volume can have an impact on postoperative RF and increase the risk of CKD.

Comprehensive Management of Renal Masses in Solitary Kidneys

BackgroundA renal mass in a solitary kidney (RMSK) has traditionally been managed with partial nephrectomy (PN), although radical nephrectomy (RN) is occasionally required. Most RMSK studies have focused on patients for whom PN was achieved. ObjectiveTo provide a comprehensive analysis of the management strategies/outcomes for an RMSK and address knowledge deficits regarding this challenging disorder. Design, setting, and participantsA total of 1024 patients diagnosed with an RMSK (1975–2022) were retrospectively evaluated. Baseline characteristics and pathologic/functional/survival outcomes were analyzed. InterventionPN/RN/cryoablation (CA)/active surveillance (AS). Outcome measurements and statistical analysisFunctional outcomes, perioperative morbidity/mortality, and 5-yr recurrence-free survival (RFS) were evaluated. Kruskal-Wallis and chi-square tests were used to compare cohorts, and log-rank test and Cox proportional hazard model were used for survival analysis. Results and limitationsOf 1024 patients, 842 underwent PN (82%), 102 CA (10%), 54 RN (5%), and 26 AS (3%). The median tumor size and RENAL([R]adius [tumor size as maximal diameter], [E]xophytic/endophytic properties of tumor, [N]earness of tumor deepest portion to collecting system or sinus, [A]nterior [a]/posterior [p] descriptor, and [L]ocation relative to polar lines) score were 3.7 cm and 8, respectively. The median follow-up was 53 mo. For PN, 95% were clamped, and the median warm and cold ischemia times were 22 and 45 min, respectively. For PN, the median preoperative glomerular filtration rate (GFR) was 57 ml/min/1.73 m2, and the median new baseline and 5-yr GFRs were 47 and 48 ml/min/1.73 m2, respectively. Dialysis-free survival for PN was 97% at 5 yr. Twenty-two (2.1%) patients with clear-cell renal cell carcinoma and RENAL score ≥10 (median = 11) received tyrosine kinase inhibitors (TKIs) to facilitate PN, leading to 57% median decrease of tumor volume; PN was accomplished in 20 (91%). Forty-one patients had planned RN (4.0%), most often due to severe pre-existing chronic kidney disease (CKD), and 13 were converted from PN to RN (1.5%). Clavien III–V perioperative complications were observed in 80 (8%) patients and 90-d mortality was 0.6%. Five-year RFS for PN, CA, and RN were 83%, 80%, and 72%, respectively (p = 0.03 for PN vs RN). ConclusionsNephron-sparing approaches are feasible and successful in most RMSK patients. PN for an RMSK is often challenging but can be facilitated by selective use of TKIs. RN is occasionally required due to severe CKD, over-riding oncologic concerns, or conversion from PN. This is the first large RMSK study to provide a comprehensive analysis of all management strategies/outcomes. Patient summaryKidney cancer in a solitary kidney is a major challenge for achieving cancer-free status and avoiding dialysis. Although partial nephrectomy is the principal treatment for a renal mass in a solitary kidney, other options are occasionally required to optimize outcomes.

Improvement of Renal Function after Pyeloplasty Determined by 99mTc DTPA Renogram

Objective: To evaluate the improvement of renal function after pyeloplasty measured by 99mTc-DTPA renography. Materials and Methods: This hospital based quasi experimental study was done in the department of urology, National Institute of Kidney Diseases and Urology (NIKDU) and Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from July 2014 to December 2020. Sixty patients were included in this study who underwent Anderson-Hynes (A-H) dismembered pyeloplasty for pelviureteric junction (PUJ) obstruction. All patients were evaluated with diuretic 99mTc- DTPA renogoam before and at 3 and 6 months after operation. Improvement of renal function was evaluated by comparing preoperative and postoperative differential renal function (DRF) and glomerular filtration rate (GFR). Results: Sixty patients with unilateral hydronephrosis due to PUJ obstruction were included in this study. Of these patients 34 male and 26 female with mean age of 15.6 years (ranged from 3 – 38 years). Out of 60 patients, 56.7% had left sided hydronephrosis and 43.3% had right sided hydronephrosis. Diuretic renography was done using 99mTc- DTPA in all patients preoperatively and at 3 and 6 months postoperatively. Preoperative mean DRF and GFR were compared with post-operative findings. The mean preoperative DRF in the study was 16.72 ± 8.35% at baseline which increased to 26.03 ± 7.08% at the end of 3rd month and 28.15 ± 5.84% at the end of 6th month. The mean preoperative GFR was 14.29 ± 6.73 ml/min/1.73 m2 at baseline which increased to 24.13 ± 5.31ml/min/ 1.73 m2 at the end of 3rd month and 27.38 ± 4.78 ml/min/1.73 m2 at the end of 6th month. Conclusion: The result demonstrates that, after pyeloplasty renal function improves. Highest recovery of renal function occurs in children and patients with poor pre-operative DRF and GFR. Bangladesh J. Urol. 2021; 24(2): 155-160

Parenchymal Mass Loss During Partial Nephrectomy: Role of Devascularized Parenchymal Mass and Excised Parenchymal Mass and Impact on Functional Preservation.

To evaluate the importance of devascularized parenchymal mass(DPM) and excised parenchymal mass(EPM) in functional preservation after standard partial nephrectomy(SPN). Forty-one patients who underwent pure tumor enucleation(TE) and 52 patients who underwent SPN with necessary data were included. As no EPM was lost in TE, the TE samples were used to estimate the degree of volume shrinkage that occurred when the measurements were performed in vivo with blood flow versus ex vivo without, and the shrinkage ratio was calculated as specimen volume divided by tumor volume in vivo. In SPN, the specimen volume comprised tumor volume plus EPM. The EPM was calculated as specimen volume divided by shrinkage ratio minus tumor volume in vivo. The DPM was defined as total ipsilateral parenchymal mass loss minus EPM. T tests, χ2 test, and Mann-Whitney U tests were employed to compare clinical characteristics. Multivariate analysis was used to identify variables that correlated with glomerular filtration rate(GFR) preservation. The mean sizes of devascularized and excised parenchymal masses were 13.6 cm3 and 5.2 cm3 (P=.01), which accounted for 7.8% and 3.4% of preoperative ipsilateral parenchymal mass (P=.03) in SPN, respectively. The shrinkage ratio was 0.71 and correlation coefficient was 0.965. After stepwise regression, DPM, and preoperative GFR were significantly associated with global GFR preservation. The DPM comprises most of parenchymal mass loss after SPN and plays a more important role than EPM on functional outcomes. Surgeons should pay more attention to reducing devascularization during partial nephrectomy.

Evaluation of Renal Function after Partial Nephrectomy and Detection of Clinically Significant Acute Kidney Injury.

Background and Objectives: Consequences of partial nephrectomy (PN), intraoperative hypotension (IOH) and postoperative neutrophil to lymphocyte ratio (NLR) may cause postoperative acute kidney injury (AKI) and in long-term-chronic kidney disease (CKD). Our study aimed to identify the AKI incidence after PN, to find clinically significant postoperative AKI and renal dysfunction, and to determine the predictor factors. Materials and Methods: A prospective observational study consisted of 91 patients who received PN with warm ischemia, and estimated preoperative glomerular filtration rate (eGFR) ≥ 60 mL/min and without abnormal albuminuria. Results: 38 (41.8%) patients experienced postoperative AKI. Twenty-one (24.1%) patients had CKD upstage after 1 year follow-up. Sixty-seven percent of CKD upstage patients had AKI 48 h after surgery and 11% after 2 months. All 15 (16.5%) patients with CKD had postoperative AKI. With IOH, OR 1.07, 95% CI 1.03–1.10 and p < 0.001, postoperative NLR after 48 h (OR 1.50, 95% CI 1.19–1.88, p < 0.001) was the major risk factor of AKI. In multivariate logistic regression analysis, the kidney’s resected part volume (OR 1.08, 95% CI 1.03–1.14, p < 0.001) and IOH (OR 1.10, 95% CI 1.04–1.15, p < 0.001) were retained as statistically significant prognostic factors for detecting postoperative renal dysfunction. The independent risk factor for clinically significant postoperative AKI was only IOH (OR, 1.06; p < 0.001). Only AKI with the CKD upstage group has a statistically significant effect (p < 0.0001) on eGFR 6 and 12 months after surgery. Conclusions: The presence of AKI after PN is not rare. IOH and NLR are associated with postoperative AKI. The most important predictive factor of postoperative AKI is an NLR of over 3.5. IOH is an independent risk factor for clinically significant postoperative AKI and together with kidney resected part volume effects postoperative renal dysfunction. Only clinically significant postoperative AKI influences the reduction of postoperative eGFR after 6 and 12 months.