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Title: Clinical consequences of nephrectomy performed on medical indications

Abstract:

Introduction . Knowing the relation between decrease in the number of nephrons and progressing kidney damage caused by it in the experimental model, we can treated each nephrectomy from medical reasons as a risk factor for development of chronic kidney disease (CKD). Epidemiological data in Europe and in the world show that chronic kidney disease is a serious social problem and, besides cardiovascular diseases, diabetes, obesity and hypertension, is included amongst civilisation diseases. In most of the countries, renal screenings registered frequency of the stage 5 chronic kidney disease, only in the recent studies data concerning all CKD stages were collected together, on a basis of albuminuria or an incorrect value of the glomerular filtration rate.In the current bibliography no studies are available covering large groups of patients that would estimate the nephrectomy effect on functioning of the remaining kidney and on development of possible cardiovascular complications. More specific data assessing effects of nephrectomy provide studies carried out in animals. Recently published data concerning studies in a large group of kidney donors consider that problem mainly in terms of them being at risk of developing chronic kidney disease, but they unfortunately do not provide information concerning development of chronic kidney disease at all its stages in patients after nephrectomy or an assessment of risk of developing cardiovascular diseases in persons with a reduced number of functioning nephrons. Diagnosing kidney disease at an early stage and correct management of a patient with mild kidney disease results in a slower disease progression, or may even help to prevent its development; therefore, awareness of that risk inclines us to act in accordance with the adage “prevention is better than cure”, which is not only better for a patient but also from an economic point of view.Aim of the study.The aim of this study was a retrospective analysis of clinical effects of nephrectomy, taking into account: indications for nephrectomy, evaluation of a functional status of the sole kidney based on:USG scan, serum creatinine levels, eGFR estimated with the MDRD and Cockcroft- Gault methods as well as, occurrence of proteinuria in patients before and after nephrectomy.Addictionally hypertension in patients after nephrectomy. complications in the postoperative period and cardiovascular complicationswere evaluated. ; Material and method.The study covered 182 patients after nephrectomy for various reasons in the period from 1979 to 2008. A part of the studied group consisted of patients being provided health care at the Renal Clinic at the University Hospital and the Małopolskie Complex of Specialist Clinic BATOREGO 3 in Krakow, and the Urology Clinic at the Podkarpackie Voivodeship Hospital in Krosno. Reasons for carrying out nephrectomy in the studied group were not uniform, they included: kidney cancer, hydronephrosis, pyonephrosis, renal calculus, kidney cysts, renal pelvis tumour, or kidney afunction. The average period of observation of patients was 5.9 years; minimum time from the operation was 1 year, while the maximum time from the operation reached 30 years. In all patients, the morphological and functional kidney status was evaluated before and after nephrectomy, using ultrasound scanning. The functional status of the remaining kidney was evaluated on a basis of serum levels of creatinine, urea, sodium and potassium, as well as the glomerular filtration rate estimated using Cockcroft-Gault formula and the abbreviated MDRD formula. Changes in the urinalysis were also evaluated with particular attention paid to proteinuria occurrence, and blood pressure values before and after nephrectomy were verified for possible hypertension. The material was also reviewed for frequency and types of complications occurring in a postoperative period and after a long time in individual patients covered by the study. The collected material was entered into a database developed in the Excel 2003 application. The statistical analysis of the parameters listed above was carried out with SPSS 17.0 PL and Statistica 7.0 PL applications.Results.The average size of kidneys: length and width as estimated by the ultrasound scan, was analysed for change in the size following nephrectomy, and it was found that the average length and width of the sole kidney remaining after nephrectomy in the long-term observation increased by 20.54 mm, representing 20.2% of the initial dimension before the operation, and by 6.88 mm, representing 13.5%, respectively, and that was statistically significant for p=0.000. It was also found that average creatinine serum levels increased both in an early and in the long-term observation by 25.39 mmol/l and by 4.32 mmol/l, respectively, and that was statistically significant for p<0/0001. At the same time a correlation was found between a creatinine level in the long term observation and the age, with p=0.01. It was also verified whether the size of the kidney in the long term observation was correlated with the eGFR value (Cockcroft-Gault) during control after long time from nephrectomy. A correlation was found between eGFR and the kidney length and width in the long term observation, and the age, significance p<0.05. On a basis of calculations it was found that the average eGFR level calculated using the MDRD formula was lower after nephrectomy, both during the early and the long-term observation, by 2.58 ml/min/1.73 and by 6.81 ml/min/1.73, respectively. Those differences were statistically significant with p=0.006. On a basis of ; calculations it was found that the average systolic and diastolic pressure after nephrectomy in the long term observation increased by 3.46 mmHg and by 2.6 mmHg, respectively, and those differences were statistically significant for p<0.002. It was also shown that presence of protein in the urine in patients after nephrectomy was correlated with increased blood pressure values in those patients, versus pressure values in patients after nephrectomy without proteinuria and those differences were statistically significant for p=0.02.Conclusions.On a basis of the studies carried out the following conclusions can be drawn:1.In patients after nephrectomy compensatory renal hypertrophy was found. The average length and width of the sole kidney after nephrectomy increases, the length by 20.54 mm (20.2% of the initial dimension before surgery) and width by 6.88 mm (13.5%). It is statistically significant for p=0.000.2. The average creatinine serum levels increases both in an early and in the long-term observation by 25.39 mmol/l, representing 23.3% of the initial value and by 4.32 mmol/l, representing 4.0% of the initial value before nephrectomy, respectively, and it is statistically significant for p<0/0001.3. The average creatinine level in the long term observation is positively correlated with the age, and it is statistically significant for p=0.01.4. The average eGFR level calculated using the MDRD formula is lower after nephrectomy, both in the early and the long-term observation, by 2.58 ml/min/1.73, representing 4.2% of the initial value, and by 6.81 ml/min/1.73, representing 11% of the initial value, respectively. The difference is statistically significant for p=0.006.5. The average systolic and diastolic pressure after nephrectomy in the long term observation was higher by 3.46 mmHg, representing 2.6% of the initial value, and by 2.6 mmHg, representing 3.3 % of the value before nephrectomy, respectively. Those differences are statistically significant for p<0.002.6. Presence of protein in the urine in patients after nephrectomy is correlated with increased blood pressure values: systolic and diastolic, in those patients, versus pressure values in patients after nephrectomy without proteinuria, those values were higher by 4.8 mmHg, representing 3.6% of the initial value, and by 3.65 mm Hg, representing 4.5% of the initial value, respectively. Those differences were statistically significant for p=0.02.7. eGFR in the long-term control after nephrectomy is correlated with kidney dimensions in the long-term control after nephrectomy, and with the age. It is statistically significant for p<0.05.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Władysław Sułowicz

Date issued:

2012

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3505

Call number:

ZB-117990

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Oct 29, 2019

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