title: Predictors for postoperative renal function after open partial nephrectomy: including postoperative biomarkers.
abstract: OBJECTIVE
  To assess the predictors of postoperative renal insufficiency after open partial nephrectomy.
  
  
  METHODS
  A total of 195 patients who underwent open partial nephrectomy were the participants in this study. Patients with a decrease in the estimated glomerular filtration rate of >25% from baseline were evaluated on the basis of multiple factors including patient-specific, surgical, tumor and postoperative factors. Postoperative estimated glomerular filtration rate data were recorded between 3 and 6 months after surgery.
  
  
  RESULTS
  Of the 195 patients, 18 (9%) had a decrease in estimated glomerular filtration rate of >25%. Percentage of preserved renal parenchyma (P = 0.0078), nearness of tumor to renal sinus (P = 0.0108), location of tumor to middle part of kidney (P = 0.0112), postoperative highest lactase dehydrogenase (P < 0.0001), postoperative body temperature (P = 0.0314) and postoperative acute kidney injury (P < 0.0001) were significantly different between patients with a decrease in estimated glomerular filtration rate of >25% and those with a decrease in estimated glomerular filtration rate ≤25% on univariate analysis. Multivariate analysis showed that postoperative highest lactase dehydrogenase (P = 0.0408) and acute kidney injury (P = 0.0002) were independent predictors for decrease of estimated glomerular filtration rate >25%. In contrast, patient characteristic factors (chronic kidney disease stage), surgical factors (clamping time and PPRP) and tumor factors (radius, endophytic/exophytic, nearness and location component) were not significant predictors.
  
  
  CONCLUSIONS
  Postoperative factors, lactase dehydrogenase and acute kidney injury, were strong predictors for renal insufficiency after open partial nephrectomy. Thus, a strict follow up is advisable in patients showing high postoperative levels of these two biomarkers.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. himmeno1192@yahoo.co.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.forename: Junpei
authors.initials: J
authors.lastname: Iizuka
authors.forename: Eri
authors.initials: E
authors.lastname: Tomita
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase