Analysis of risk factors for progressive renal atrophy after nephron-sparing surgery
Objective To investigate the progression characteristics and risk factors of chronic re-nal injury after nephron-sparing surgery(NSS).Methods Based on 3D Slicer measurement,the renal pa-renchyma volume(RPV)of 210 patients who underwent NSS in the Department of Urology,PLA General Hospital were analyzed.The annual RPV atrophy rate ≥5%was defined as atrophy group,and<5%was defined as non-atrophy group.There were 77 cases in atrophy group,including 57 males and 20 females.There were 48 cases of obesity[body mass index(BMI)≥25],38 cases of hypertension,68 cases of T1a stage and 9 cases of T1b stage.There were 133 cases in non-atrophy group,including 106 males and 27 fe-males.There were 72 cases of obesity,34 cases of hypertension,119 cases of T1 a stage and 14 cases of T1 b stage.Multivariate Logistic regression analysis was used to analyze the independent risk factors of pro-gressive renal atrophy after NSS.Results The RPV of the affected side was(140.41±34.73)ml at the first follow-up after NSS and decreased to(131.29±34.98)ml(t=9.450,P<0.05)at the last follow-up after NSS.There were 77 cases in the atrophy group and 133 cases in the non-atrophy group.Univariate a-nalysis revealed age ≥60 years(x2=6.803,P<0.05),hypertension(x2=12.247,P<0.05)and warm ischemic time(WIT)≥25 min(x2=8.587,P<0.05)were risk factors.Multivariate Logistic regression analysis showed that hypertension[odds ratio(OR)=2.246,95%confidence interval(CI):1.186-4.251,P<0.05]and WIT ≥25 min(OR=2.249,95%CI:1.150-4.402,P<0.05)were independent risk factors for progressive renal atrophy after NSS.Conclusion The RPV of the affected side showed a progressive downward trend after NSS.Hypertension and WIT ≥25 min were independent risk factors for progressive renal atrophy after NSS.