Correlation between preoperatively predicted and postoperatively observed renal function using an imaging-based approach: A retrospective cohort study

摘要

The aim of the present study was to preoperatively predict renal function following partial nephrectomy (PN) using an imaging-based approach and to examine the correlation between preoperatively predicted and postoperatively observed renal function in the study cohort. A total of 128 consecutive patients who underwent PN between May 2015 and March 2018 and had available clinical data were included in this study. A hand-scripting method was used to estimate the defected volume (Vdef) from preoperative computerized tomography scans, whereas a cylindrical method was used to obtain preoperative renal volume (Vpre). The function index (FI) was proposed as a new term to estimate preserved parenchyma percentage following PN. The FI was defined as f=(Vpre-Vdef)/Vpre for the operated kidney and adjusted as FI=0.5 × (f + 1) for the bilateral kidneys. The estimated glomerular filtration rates (GFRs) before surgery, one day after surgery and ~12 months after surgery were calculated using the Modification of Diet in Renal Disease Study equation. The GFR rate after PN was predicted by multiplying the preoperative GFR by the FI. The predictive role of the FI was further tested using multiple linear regression and correlation analyses. The median FI in the present study was 94% for unilateral kidney surgery and adjusted to 97% for bilateral kidneys. Linear correlation analysis revealed that the predicted GFR significantly correlated with the observed immediate postoperative GFR (R , 0.594) and observed late postoperative GFR (R , 0.828). In multivariate regression analysis, preoperative GFR (P<0.01) and warm ischemic time (P<0.01) were identified as independent determinants of the immediate postoperative renal function, whereas only FI (P<0.01) and preoperative GFR (P<0.01) were identified as independent determinants of late renal function after PN. The preoperatively predicted renal function using an imaging-based approach had a significant positive correlation with the postoperatively observed renal function. The FI estimated from the preoperative diagnostic images in the present study was identified as an independent determinant of long-term renal function after PN.