Risk Factors And Predictive Value Of Acute Kidney Injury After Laparoscopic Partial Nephrectomy

Objective:To investigate the risk factors and predictive value of acute kidney injury（AKI）after laparoscopic partial nephrectomy（LPN）.Methods:Clinical data of 60 patients with renal cell carcinoma（RCC）who received LPN in Urology Department of the Third Medical Center of Chinese PLA General Hospital from November 2020 to June 2021 were retrospectively analyzed.The diagnosis of AKI according to the kidney disease improving global outcomes（KDIGO）standard.According to the occurrence of postoperative AKI,the patients were divided into AKI group（n=26）and non-AKI group（n=34）.Patients’age,gender,preoperative hemoglobin（Hb）,complicating disease,length of hospital stay,as well as the pre-and 48h after post-operative serum creatinine（Scr）,estimated glomerular filtration rate（eGFR）,β₂-microglobulin（β₂-MG）,cystatin C（CysC）and fasting plasma glucose（FPG）were collected.The risk factors for AKI after LPN were analyzed by univariate and multivariate logistic regression,and the predictive value of risk factors for AKI after LPN in RCC patients was analyzed by receiver operating characteristic（ROC）curve.Results:Twenty-six of 60 RCC patients（43.3%）were postoperative diagnosed as AKI,among whom 22 patients（84.6%）with stageⅠAKI and 4 patients（15.4%）with stageⅡAKI.Statistical differences existed between the two groups in gender,body mass index（BMI）,preoperative hypertension,preoperative diabetes,intraoperative colloid fluid intake,renal artery occlusion time and operation time,preoperative eGFR andβ₂-MG（P<0.05）.Multivariate logistic regression analysis showed that gender（male）,BMI,intraoperative colloid fluid intake and renal artery occlusion time were independent risk factors for AKI after LPN（P<0.05）.ROC curve analysis showed that the cut-off value of BMI,intraoperative colloid fluid intake and renal artery occlusion time were 24.9kg/m²,500ml,24min;the sensitivity was 88.5%,73.1%,73.1%;the specificity was64.7%,70.6%,73.5%;and the area under curve was 0.811,0.755 and 0.764,respectively.Conclusion:BMI,intraoperative colloid fluid intake and renal artery occlusion time were risk factors for AKI after LPN and had certain predictive value,while gender（male）was also an independent risk factor for AKI after LPN.