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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Article info
Publication history
Published online: February 20, 2017
Accepted:
February 13,
2017
Received:
December 15,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: Kyung Hwa Choi received support for this study from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2015R1C1A1A02037466).
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