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Effect of post-nephrectomy acute kidney injury on renal outcome: a retrospective long-term study

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Abstract

Purpose

The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term.

Methods

This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥ 40% decline in glomerular filtration rate or new-onset severe proteinuria (> 500 mg/24 h). Clinical correlates of acute kidney injury and renal outcome were also examined.

Results

106 patients were enrolled. 52 patients had post-operative acute kidney injury with a median increment of serum creatinine of 0.67 [0.48–0.86] mg/dl; in these patients, serum creatinine and urea increased from the first day post-nephrectomy while contraction of urinary output was found in 7 patients. Older age [OR: 1.72; 95% CI 1.05–2.82; P = 0.030] associated with post-operative acute kidney injury. Over a median follow-up of 8.9 [95% CI 3.1–24.2] years, the combined renal outcome occurred, respectively, in 28 (53.8%) and 14 (25.9%) patients with and without acute kidney injury (P = 0.003). Logistic regression analysis showed that acute kidney injury (OR: 3.22; 95% CI 1.35–7.66; P = 0.008) and male gender (OR: 2.72; 95% CI 1.08–6.85; P = 0.034) were associated with poor renal outcome after adjustment for main comorbidities.

Conclusions

In our population of referred patients, acute kidney injury after unilateral nephrectomy was common and associated with progressive chronic kidney disease, especially in older males.

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Authors and Affiliations

  1. Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell’Invecchiamento, University of Campania “Luigi Vanvitelli”, Via M. Longo 50, 80138, Naples, Italy

    Carlo Garofalo, Maria Elena Liberti, Giuseppe Conte, Luca De Nicola, Roberto Minutolo & Silvio Borrelli

  2. Division of Nephrology at University of Naples “Federico II”, Naples, Italy

    Domenico Russo & Luigi Russo

  3. Division of Nephrology at University of Catanzaro “Magna Graecia”, Catanzaro, Italy

    Giorgio Fuiano & Paola Cianfrone

Authors
  1. Carlo Garofalo
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  2. Maria Elena Liberti
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  3. Domenico Russo
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  4. Luigi Russo
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  5. Giorgio Fuiano
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  6. Paola Cianfrone
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  7. Giuseppe Conte
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  8. Luca De Nicola
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  9. Roberto Minutolo
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  10. Silvio Borrelli
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Contributions

BS, CG, NL, GC and MR: protocol/project development, data collection or management, data analysis, manuscript writing/editing. CP, FG, LME, RD and RL: data collection or management

Corresponding author

Correspondence to Carlo Garofalo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving Human Participants and/or Animals

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Garofalo, C., Liberti, M.E., Russo, D. et al. Effect of post-nephrectomy acute kidney injury on renal outcome: a retrospective long-term study. World J Urol 36, 59–63 (2018). https://doi.org/10.1007/s00345-017-2104-7

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  • DOI: https://doi.org/10.1007/s00345-017-2104-7

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