Parsiyel Nefrektomize Hastalarda Aort ve Renal Arterde Ölçülen Kalsiyum Skorunun Böbrek Fonksiyonlarına Etkisi

Abstract

We analyzed 139 patients recieved partial nephrectomy (PN) between November 2007 and October 2016, in order to assess the impact of calcium score, an indicator of atherosclerotic renal vein and aorta on renal function. Patients with non-contrast computed tomography scans and renal function measurements before and after the operation in the perioperative year were included in our study. Patients with scans not allowing calcium score measurement and patients lack of postoperative data were excluded. Patients’ preoperative, postoperative and last visit laboratory findings were assessed. Last visit renal function evaluations were made by creatinin, BUN and GFR(calculated with MDRD formula) starting after postoperative first month. Patients’ median age was found 54, median follow-up time was 25.5 months and female to male ratio was 52/87. Patients’ preoperative creatinin, BUN and GFR values were 0.86 (±0.22) mg/dL, 15.55 (±5.05) mg/dL and 95.75 (±24.62) mL/dk/1.73 m2 respectively. Postoperative creatinin, BUN and GFR values were 1.00 (±0.30) mg/dL, 14.69 (±5.22) mg/dL, 82.72 (±25.49) mL/dk/1,73 m2 respectively. Patients’ creatinin, BUN and GFR values at last visit were 1.01 (±0.38) mg/dL, 17.75 (±7.58) mg/dL, 82.30 (±24.43) mL/dk/1.73 m2 respectively. Age, presence of hypertension and diabetes, tumor location, aort and renal artery calcium scores were found to have negative affect on renal functions on the last visit. Gender was found to have no significant effect on last visit GFR values altough male patients were found having higher creatinin and BUN levels. Aortic calcium scores were significantly higher in male patients, older patients, patients with hypertension and diabetes. Aortic calcium scores were in positve correlation with preoperative (r=0.358;p=0.000), postoperative (r=0.324;p=0.000) and last visit (r=0.492;p=0.000) creatinin levels. Preoperative (r=0.500;p=0.000), postoperative (r=0.466;p=0.000) and last visit (r=0.548;p=0.000) BUN levels were also found correlated with high aortic calcium scores. Aortic calcium scores were in negative corelation with preoperative (r=-0.344;p=0.000), postoperative (r=-0.364;p=0.000) last visit (r=-0.490;p=0.000) GFR values. High renal arterial calcium scores were associated only with the increased creatinin values at last visit (r=0.177;p=0.042). Increased renal arterial calcium scores were significantly correlated with high BUN levels at preoperative (r=0.261;p=0.002), postoperative (r=0.288;p=0.000) and last visit (r=0.341;p=0.000) measurements. Preoperative (r=-0.175;p=0.040), postoperative (r=-0.202;p=0.040) and last visit (r=-0.207;p=0.017) GFR values were negatively correlated with renal arterial calcium scores. These findings suggest that atherosclerosis damages both aorta and renal arteries, where it may change the type of the surgery considering long term good renal function and also patients should be followed for a long time after partial nephrectomy.