Association Of Metabolic Syndrome With Kidney Function After Radical Nephrectomy And Pathological Changes Associated With Metabolic Syndrome

Background and objectiveThe worldwide prevalence of metabolic syndrome(MS)is increasing and has been proves to be associated with chronic kidney disease(CKD).Recently,the prevalence of renal cell carcinoma(RCC)is increasing,and radical nephrectomy,as one of the main treatment for RCC,will affect the recovery of postoperative renal function.Previous studies have proved that preoperative with MS will affect the recovery of postoperative renal function,but specific changes have not been studied.The aim of this study was to evaluate the impact of MS on renal function in patients who underwent radical nephrectomy,and it's kidney pathological changes.MethodsRetrospective studies were conducted on patients undergoing at 900 Hospital of the Joint Logistics Team from December 2012 to January 2017.32 cases of radical nephrectomy with metabolic syndrome were identified,and 32 patients who were matched with age,sex,tumor diameter,surgical methods were used as non-MS group.Presence of metabolic syndrome was defined by using Chinese Diabetes Society in 2004.The specimens in this study were selected from renal cortex that was more than 2cm from the edge of renal tumor.Histological sections of non-neoplastic kidney parenchyma were processed for HE and PASM-Masson staining,and diagnosis was made by pathologists.The Estimated glomerular filtration rate(eGFR)of pre-operation and 1 week,3 month,1 year,2 year after operation were analyzed for evaluating the changes of renal function with MS after radical nephrectomy.Results1.The overall trend of postoperative eGFR in two groups was increased after decreased.The recovery of kidney function in the MS group was 1 year after surgery,while the non-MS group were 1 week after surgery.2.There was a statistically significant difference in eGFR between the two groups(P<0.05),and eGFR changed with time(P<0.05),but there was no difference in the rate of change between groups and time.3.MS group's postoperative renal function staging last for above stage 3a more than non-MS(P=0.048).4.MS compared with non-MS had greater prevalence of tubular atrophy(P=0.018)and interstitial fibrosis(P=0.008).However,there was no significant statistical difference in arterial lesions between the two groups(P=0.545).Patients with MS had greater glomerulosclerosis(P=0.030).ConclusionThe pathological changes associated with metabolic syndrome were glomerulosclerosis and tubulointerstitial fibrosis.Patients with metabolic syndrome in unilateral nephrectomy will affect the recovery of postoperative eGFR.Aggressive screening and management may protect kidney function in patients with metabolic syndrome.