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. 2023 Aug 12;26(9):107610.
doi: 10.1016/j.isci.2023.107610. eCollection 2023 Sep 15.

Long-term effect of acute ischemic injury on the kidney underwent clamped partial nephrectomy

Zhaohui Zhou  1   2 , Zhiyong Li  1   2 , Kang Ning  1   2 , Longbin Xiong  1   2 , Huiming Liu  1   2 , Yixin Huang  1   2 , Xin Luo  1   2 , Yulu Peng  1   2 , Lijie Chen  3 , Binglei Ma  1   2 , Xiangpeng Zou  1   2 , Wensu Wei  1   2 , Cheng Luo  1   2 , Hui Han  1   2 , Shengjie Guo  1   2 , Pei Dong  1   2 , Fangjian Zhou  1   2 , Chunping Yu  4 , Zhiling Zhang  1   2
Affiliations

Long-term effect of acute ischemic injury on the kidney underwent clamped partial nephrectomy

Zhaohui Zhou et al. iScience. .

Abstract

GFR reaches a new baseline, primarily correlating with nephron-mass preservation, 1-12 months after partial nephrectomy (PN). However, does the ipsilateral GFR experience subsequent decline, and does acute ischemic injury has long-term effect on the operated kidney? 319 patients with two kidneys and unilateral clamped PN were analyzed. All had preoperative, new-baseline, and latest follow-up imaging/serum creatinine levels. Annual ipsilateral GFR decline rate (AIGDR) was defined as new-baseline GFR minus latest follow-up GFR normalized by new-baseline GFR, per year. Spectrum score was used to reflect the degree of acute ischemic injury in the operated kidney. 100 subjects searching for health screening served as controls. Predictive factors for AIGDR were assessed. The median AIGDR was 2.25%, significantly higher than controls (0.88%, p = 0.036). With some contralateral hypertrophy, the global annual GFR decline was similar to that of controls (0.81% vs. 0.88%, p = 0.7). Spectrum score correlated significantly with AIGDR (p = 0.037). These results support that acute ischemic injury has long-term effect on the operated kidney.

Keywords: Endocrinology; Medical endocrinology; Pathophysiology; Public health.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
The change of GFR (ml/min/1.73m2) in study group (preoperative, new baseline and latest follow-up) and control group (A) Ipsilateral GFR dropped sharply in the short-term after PN and then showed mild decline beyond new baseline GFR. Data are presented as the individuals and the median with interquartile range. (B) Contralateral GFR showed compensation beyond new baseline. Data are presented as the individuals and the median with interquartile range. (C) Global GFR decreased both at short-term and beyond new baseline. Data are presented as the individuals and the median with interquartile range. (D) Global GFR decline in control group over time (n = 100). Data are presented as the individuals and the median with interquartile range. (E) Annual GFR decline rate beyond new baseline GFR was significantly higher in the operated kidney than control group. (F) Annual decline rate of global GFR beyond new baseline was similar between study group and control group.
Figure 2
Figure 2
Factors correlated with annual subsequent ipsilateral GFR decline rate (A–E) Correlation between annual GFR decline rate beyond new baseline GFR and (A) age, (B) ischemic time, (C) Spectrum score, (D) ischemic type, and (E) comorbidities of HTN, DM, and/or preexisting CKD. Spectrum score: this score ideally ranges from 0 to 1, with a score of 1 representing temporary complete shutdown of the ipsilateral kidney with serum creatinine rising to the level of function only provided by the contralateral kidney and a score of 0 representing only minimal rise of the serum creatinine reflecting only minimal loss of parenchymal volume in the ipsilateral kidney.
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