Adaptive functional change of the contralateral kidney after partial nephrectomy

作者：Choi Se Young; Yoo Sangjun; You Dalsan; Jeong In Gab; Song Cheryn; Hong Bumsik; Hong Jun Hyuk; Ahn Hanjong; Kim Choung Soo^*

来源：American Journal of Physiology - Renal Fluid and Electrolyte Physiology, 2017, 313(2): F192-F198.

DOI：10.1152/ajprenal.00058.2017

• nephrectomy
• glomerular filtration rate
• diethylene triamine pentaacetic acid
• recovery of function
• kidney function tests

Partial nephrectomy aims to maintain renal function by nephron sparing; however, functional changes in the contralateral kidney remain unknown. We evaluate the functional change in the contralateral kidney using a diethylene triamine penta-acetic acid (DTPA) renal scan and determine factors predicting contralateral kidney function after partial nephrectomy. A total of 699 patients underwent partial nephrectomy, with a DTPA scan before and after surgery to assess the separate function of each kidney. Patients were divided into three groups according to initial contralateral glomerular filtration rate (GFR; group 1: <30 ml.min(-1).1.73 m(-2), group 2: 30-45 ml.min(-1).1.73 m-2,and group 3: >45 ml.min(-1).1.73 m-2). Multiple-regression analysis was used to identify the factors associated with increased GFR of the contralateral kidney over a 4-yr postoperative period. Patients in group 1 had a higher mean age and hypertension history, worse American Society of Anesthesiologists score, and larger tumor size than in the other two groups. The ipsilateral GFR changes at 4 yr after partial nephrectomy were -18.9, -3.6, and 3.9% in groups 1, 2, and 3, respectively, whereas the contralateral GFR changes were 10.8, 25.7, and 38.8%. Age [beta: -0.105, 95% confidence interval (CI): -0.213; -0.011, P < 0.05] and preoperative contralateral GFR (beta: -0.256, 95% CI: -0.332; -0.050, P < 0.01) were significant predictive factors for increased GFR of the contralateral kidney after 4 yr. The contralateral kidney compensated for the functional loss of the ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in younger patients with decreased contralateral renal function.

• 出版日期2017-8