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Compensatory Structural and Functional Adaptation After Nephrectomy in Obese Patients According to Waist Circumference

Published:February 20, 2017DOI:https://doi.org/10.1016/j.urology.2017.02.022

      Objective

      To investigate whether the postnephrectomy renal adaptation mechanism, focused on functional hyperfiltration as well as structural hypertrophy, was affected by abdominal obesity.

      Materials and Methods

      We retrospectively evaluated 358 patients who underwent simple or radical nephrectomy and nephroureterectomy between 2009 and 2013. Patients were classified according to waist circumference (WC), with values >102 cm in men and >88 cm in women considered high (obesity). Functional renal volume (FRV) was measured using computed tomography performed preoperatively and 6 months postoperatively to evaluate the degree of remnant kidney hypertrophy. The degree of hyperfiltration was calculated from the difference between the preoperative and postoperative glomerular filtration rate (GFR)/FRV.

      Results

      The mean preoperative GFR, FRV, and GFR/FRV were 72.1 mL/min/1.73 m2, 282.8 cm3, and 0.25 mL/min/1.73 m2/cm3, respectively. The percent GFR reduction was significantly greater in the high WC group (high, 25.9% vs normal, 16.0%, P = .036), although the degree of hypertrophic volume in the remnant kidney showed no difference. The change in GFR/FRV was statistically lower in the high WC group (high, 25.7% vs normal, 40.2%, P = .009). The factors associated with postoperative increased GFR/FRV were low preoperative GFR, proteinuria, high predictive preserved functional parenchymal volume ratio, absence of hypertension, increased levels of high-density lipoprotein cholesterol, and normal WC (all P < .05).

      Conclusion

      Patients with high WC might have a large reduction in postoperative renal function, owing to a lower degree of functional hyperfiltration.
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      References

        • Fong D.
        • Denton K.M.
        • Moritz K.M.
        • et al.
        Compensatory responses to nephron deficiency: adaptive or maladaptive?.
        Nephrology (Carlton). 2014; 19: 119-128
        • Choi D.K.
        • Jung S.B.
        • Park B.H.
        • et al.
        Compensatory structural and functional adaptation after radical nephrectomy for renal cell carcinoma according to preoperative stage of chronic kidney disease.
        J Urol. 2015; 194: 910-915
        • Jeon H.G.
        • Gong I.H.
        • Hwang J.H.
        • et al.
        Prognostic significance of preoperative kidney volume for predicting renal function in renal cell carcinoma patients receiving a radical or partial nephrectomy.
        BJU Int. 2012; 109: 1468-1473
        • Mueller T.F.
        • Luyckx V.A.
        The natural history of residual renal function in transplant donors.
        J Am Soc Nephrol. 2012; 23: 1462-1466
        • Mjoen G.
        • Oyen O.
        • Midtvedt K.
        • et al.
        Age, gender, and body mass index are associated with renal function after kidney donation.
        Clin Transplant. 2011; 25: E579-E583
        • Alexander M.P.
        • Patel T.V.
        • Farag Y.M.
        • et al.
        Kidney pathological changes in metabolic syndrome: a cross-sectional study.
        Am J Kidney Dis. 2009; 53: 751-759
        • Ohashi Y.
        • Thomas G.
        • Nurko S.
        • et al.
        Association of metabolic syndrome with kidney function and histology in living kidney donors.
        Am J Transplant. 2013; 13: 2342-2351
        • Rook M.
        • Bosma R.J.
        • van Son W.J.
        • et al.
        Nephrectomy elicits impact of age and BMI on renal hemodynamics: lower postdonation reserve capacity in older or overweight kidney donors.
        Am J Transplant. 2008; 8: 2077-2085
        • Skorecki K.
        Brenner & Rector's The Kidney [electronic resource].
        Elsevier/Saunders, Philadelphia, PA2016
        • Hayslett J.P.
        • Kashgarian M.
        • Epstein F.H.
        Functional correlates of compensatory renal hypertrophy.
        J Clin Invest. 1968; 47: 774-799
        • Hosokawa Y.
        • Tanaka N.
        • Mibu H.
        • et al.
        Follow-up study of unilateral renal function after nephrectomy assessed by glomerular filtration rate per functional renal volume.
        World J Surg Oncol. 2014; 12: 59
        • Takagi T.
        • Mir M.C.
        • Campbell R.A.
        • et al.
        Predictors of precision of excision and reconstruction in partial nephrectomy.
        J Urol. 2014; 192: 30-35
        • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • Gong I.H.
        • Hwang J.
        • Choi D.K.
        • et al.
        Relationship among total kidney volume, renal function and age.
        J Urol. 2012; 187: 344-349
        • Yoon Y.E.
        • Choi K.H.
        • Lee K.S.
        • et al.
        Impact of metabolic syndrome on postdonation renal function in living kidney donors.
        Transplant Proc. 2015; 47: 290-294
        • Suneja M.
        • Kumar A.B.
        Obesity and perioperative acute kidney injury: a focused review.
        J Crit Care. 2014; 29: 694-696
        • Martin Rodriguez E.
        • Guillen Grima F.
        • Martí A.
        • et al.
        Comorbidity associated with obesity in a large population: the APNA study.
        Obes Res Clin Pract. 2015; 9: 435-447
        • Henegar J.R.
        • Bigler S.A.
        • Henegar L.K.
        • et al.
        Functional and structural changes in the kidney in the early stages of obesity.
        J Am Soc Nephrol. 2001; 12: 1211-1217
        • Isotani S.
        • Shimoyama H.
        • Yokota I.
        • et al.
        Novel prediction model of renal function after nephrectomy from automated renal volumetry with preoperative multidetector computed tomography (MDCT).
        Clin Exp Nephrol. 2015; 19: 974-981
        • Praga M.
        • Hernández E.
        • Herrero J.C.
        • et al.
        Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy.
        Kidney Int. 2000; 58: 2111-2118
        • Garg A.X.
        • Muirhead N.
        • Knoll G.
        • et al.
        Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression.
        Kidney Int. 2006; 70: 1801-1810
        • Choi K.H.
        • Yoon Y.E.
        • Kim K.H.
        • et al.
        Contralateral kidney volume change as a consequence of ipsilateral parenchymal atrophy promotes overall renal function recovery after partial nephrectomy.
        Int Urol Nephrol. 2015; 47: 25-32
        • Nyengaard J.R.
        • Bendtsen T.F.
        Glomerular number and size in relation to age, kidney weight, and body surface in normal man.
        Anat Rec. 1992; 232: 194-201
        • Taner T.
        • Iqbal C.W.
        • Textor S.C.
        • et al.
        Compensatory hypertrophy of the remaining kidney in medically complex living kidney donors over the long term.
        Transplantation. 2015; 99: 555-559
        • Simmons M.N.
        • Hillyer S.P.
        • Lee B.H.
        • et al.
        Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury.
        J Urol. 2012; 187: 1667-1673
        • Tabei K.
        • Levenson D.J.
        • Brenner B.M.
        Early enhancement of fluid transport in rabbit proximal straight tubules after loss of contralateral renal excretory function.
        J Clin Invest. 1983; 72: 871-881
        • Kamper A.L.
        • Holstein Rathlou N.H.
        • Strandgaard S.
        • et al.
        Glomerular filtration rate and segmental tubular function in the early phase after transplantation/uninephrectomy in recipients and their living-related kidney donors.
        Clin Sci. 1994; 87: 519-523
        • Salehmoghaddam S.
        • Bradley T.
        • Mikhail N.
        • et al.
        Hypertrophy of basolateral Na-K pump activity in the proximal tubule of the remnant kidney.
        Lab Invest. 1985; 53: 443-452
        • Goumenos D.S.
        • Kawar B.
        • El Nahas M.
        • et al.
        Early histological changes in the kidney of people with morbid obesity.
        Nephrol Dial Transplant. 2009; 24: 3732-3738
        • Brenner B.M.
        • Lawler E.V.
        • Mackenzie H.S.
        The hyperfiltration theory: a paradigm shift in nephrology.
        Kidney Int. 1996; 49: 1774-1777