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• W3012061641 abstract "Acute Kidney Injury (AKI) following radical nephrectomy (RN) is associated with an increased risk of morbidity and mortality due to the prolonged hospitalization for renal impairment, heart failure and sepsis. Several studies have identified, as possible risk factors, age, gender, comorbidities, and basal eGFR. However, in clinical practice does not exist a clear protocol able to stratify patients upon risk of AKI after surgery. Aim of our study was to investigate the most prominent risk factors for AKI among clinical features, in order to better tailor the medical approach before and after operation. We collected retrospectively clinical data of a group of 221 patients who underwent RN for the presence of a renal mass. To evaluate the risk to develop AKI after surgery, s-creatinine (sCr) values were collected before surgery (t0), 24h and 48h after the operation (respectively t1 and t2), and at dismissal (tf) We estimated Glomerular Filtration Rate (eGFR) with CKD-EPI formula. According to RIFLE criteria, we defined the AKI onset with a ratio of sCr/sCr(t0) higher than 1.5 during hospitalization. To investigate a correlation between renal histology and AKI development, two different renal biopsies (> 20 glomerula for each section) were performed on each renal tissues [derived from the healthy part of the removed kidney > 3cm far from tumor]. A pathological evaluation using a chronicity score (Remuzzi Score) was carried out by two different pathologists on four parameters: (a) glomerular global sclerosis, (b) tubular atrophy, (c) interstitial fibrosis and (d) arterial narrowing. Statistical analysis were performed using generalized linear model (GLM), Kruskal-Wallis test and χ-square test. Mean age of our cohort was 67 ys (s.d. ± 12), with a M:F ratio of 2.1; diabetes, hypertension, and overweight were observed in 20%, 69% and 59% of the cases, respectively. At t0, 20% of the patients had an eGFR >90ml/min/1.73m2, 45% between 60 and 90, 22% between 30 and 45, and 13% under 45. Regarding AKI onset, no significative correlation with sex, hypertension, diabetes, age and BMI was found. However, a strong significative correlation (p <0.001) was observed with the basal eGFR (or sCr) at t0 (p<0.001). In fact, the lower was the basal sCr value, the higher was the risk of AKI development during the first 72 h after RN. For a subgroup of 150 pts, no correlation was found between AKI onset and RS or its components taken individually. However, a negative correlation was found between the decay of eGFR from t0 to tf and the RS (p<0.05) suggesting that healthy kidneys with RS 0-1 display a bigger eGFR drop after surgery. From our study we observed that the only predictor for AKI in patients after RN is a better baseline renal function (both sCr and eGFR). This result is unexpected since patients with renal impairment have a reduced renal functional reserve. One possible explanation could be related to the renal synaptic connection between kidneys able to promote the hyperfiltration mechanism in both organs when nephrons start to be damaged in CKD. On the contrary, when RN is performed in pts without any signs of renal damage, the residual kidney could be not immediately ready to compensate the acute nephron loss, generating a “non adequate compensatory function mechanisms” leading to AKI" @default.
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• W3012061641 date "2020-03-01" @default.
• W3012061641 modified "2023-09-25" @default.
• W3012061641 title "SUN-026 THE RADICAL NEPHRECTOMY PARADOX: THE UNEXPECTED AKI RISK" @default.
• W3012061641 doi "https://doi.org/10.1016/j.ekir.2020.02.548" @default.
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