Abstract
Nefrektomi operasyonu geçiren hastalar genellikle öncesinde renal disfonksiyona sahip veya cerrahi sırasında meydana gelen doku kaybı nedeniyle renal yetmezlik açısından risk grubunda yer almaktadır. Bu çalışmada nefrektomi operasyonlarında genel anestezisi altında böbrek fonksiyonlarını etkileyen faktörleri değerlendirmeyi amaçladık. Kliniğimizde nefrektomi operasyonu geçiren hastaların demografik verileri, vaka türü (basit, parsiyel, radikal), laparotomi/laparoskopik, intraoperatif laktat düzeyi, anestezi süresi ve postoperatif komplikasyonlar kayıtları incelendi. Böbrek fonksiyonları preoperatif ve postoperatif dönemde (2. günde) üre, kreatinin ve tahmini glomeruler filtrasyon hızı (GFR) sonuçları ile karşılaştırıldı. Hastaların ortalama yaş 58.2 ± 13.02 iken, anestezi süresi 166.24 ± 53.01/dk, preoperatif eGFR 84.71 (67.69-90.0), postoperatif eGFR 65.09 (47.91-87.44) idi. Hastalar preoperatif ve postoperatif böbrek fonksiyon testleri kıyaslandığında; istatiksel olarak üre (p:0.01), kreatinin (p:0.01) ve GFR (p:0.01). GFR düşüşünü etkileyen faktörler, yaş (p:0.01) ve vaka türü. (p:0.01). Preoperatif döneme göre postoperatif dönemde laktat düzeylerindeki artış istatistiksel olarak anlamlıydı (p: 0.01). Laktat düzeyindeki artış komplikasyonlar (p: 0.001), vaka türü (p:0.01) ve cerrahi türü (p: 0.01) ile ilişkiliydi. Nefrektomi operasyonlarında özellikle radikal olanlarda kronik böbrek yetmezliği görülme sıklığı artmaktadır. Yaş ve vaka tipi de dikkate alınması gereken önemli parametrelerdir.
Supporting Institution
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Project Number
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Thanks
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References
- 1. Mishra A, Verma R, Bhatia V, et al. Thoracic Paravertebral Block for Postoperative Pain Management in Patients Undergoing for Nephrectomy: A Randomised Clinical Trial. Journal of Clinical & Diagnostic Research. 2018;12(10).
- 2. Lane BR, Babitz SK, Vlasakova K, et al. Evaluation of Urinary Renal Biomarkers for Early Prediction of Acute Kidney Injury Following Partial Nephrectomy: A Feasibility Study. European urology focus. 2020;6:1240-1247.
- 3. Lee HT, Ota-Setlik A, Fu Y, Nasr SH, Emala CW. Differential protective effects of volatile
- anesthetics against renal ischemia–reperfusion injury in vivo. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004;101:1313-24.
- 4. Yildirim M, Kucuk H, Demir T, et al. Early Allograft Function in Renal Transplant Recipients: Is it Affected by Volatile Anesthetics? Transplantation Proceedings; 2015: Elsevier.
- 5. Ko JS, Gwak MS, Choi SJ, et al. The effects of desflurane and sevoflurane on hepatic and renal functions after right hepatectomy in living donors. Transplant International. 2010;23:736-44.
- 6. Gazel E, Biçer S, Ölçücüoğlu E, et al. Comparison of renal function after donor and radical nephrectomy. Renal Failure. 2015;37:377-80.
- 7. Pettus JA, Jang TL, Thompson RH, Yossepowitch O, Kagiwada M, Russo P, editors. Effect of baseline glomerular filtration rate on survival in patients undergoing partial or radical nephrectomy for renal cortical tumors. Mayo Clinic Proceedings; 2008: Elsevier.
- 8. Marini F, Bellugi I, Gambi D, et al. Compound A, formaldehyde and methanol concentrations during low‐flow sevoflurane anaesthesia: comparison of three carbon dioxide absorbers. Acta anaesthesiologica scandinavica. 2007;51:625-32.
- 9. Conzen PF, Kharasch ED, Czerner SF, et al. Low-flow sevoflurane compared with low-flow isoflurane anesthesia in patients with stable renal insufficiency. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2002;97:578-84.
- 10. Fukuda H, Kawamoto M, Yuge O, Fujii K. A comparison of the effects of prolonged (> 10 hour) low-flow sevoflurane, high-flow sevoflurane, and low-flow isoflurane anaesthesia on hepatorenal function in orthopaedic patients. Anaesthesia and intensive care. 2004;32:210-8.
- 11. Cai J, Xu R, Yu X, Fang Y, Ding X. Volatile anesthetics in preventing acute kidney injury after cardiac surgery: a systematic review and meta-analysis. The Journal of thoracic and cardiovascular surgery. 2014;148:3127-36.
- 12. Sindhvananda W, Phisaiphun K, Prapongsena P. No renal protection from volatile-anesthetic preconditioning in open heart surgery. Journal of anesthesia. 2013;27:48-55.
- 13. Kher A, Meldrum KK, Wang M, et al. Cellular and molecular mechanisms of sex differences in renal ischemia–reperfusion injury. Cardiovascular research. 2005;67:594-603.
- 14. Toprak H, Şahin T, Aslan S, et al. editors. Effects of desflurane and isoflurane on hepatic and renal functions and coagulation profile during donor hepatectomy. Transplantation proceedings; 2012: Elsevier.
- 15. Brandina R, Leite KRM, Gregório EP, Fernandes KBP, Srougi M. Histologic abnormalities in non-neoplastic renal parenchyma and the risk of chronic kidney disease following radical nephrectomy. Urology. 2017;100:158-62.
- 16. Yokoyama M, Fujii Y, Iimura Y, et al. Longitudinal change in renal function after radical nephrectomy in Japanese patients with renal cortical tumors. The Journal of urology. 2011;185:2066-71.
- 17. Choi YS, Park YH, Kim Y-J, et al. Predictive factors for the development of chronic renal insufficiency after renal surgery: a multicenter study. International urology and nephrology. 2014;46:681-6.
- 18. Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. American journal of kidney diseases. 2000;36:646-61.
- 19. Duymaz G, Yağar S, Özgök A. Comparison of effects of low-flow sevoflurane and low-flow desflurane anaesthesia on renal functions using cystatin C. Turkish Journal of Anaesthesiology and Reanimation. 2017;45:93.
- 20. Ebert TJ, Arain SR. Renal responses to low-flow desflurane, sevoflurane, and propofol in patients. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000;93:1401-6.
Abstract
Patients who have had a nephrectomy usually have a history of renal dysfunction or are at risk for kidney failure due to tissue loss during surgery. In this study, our aim was to evaluate the factors affecting acute renal function in nephrectomy surgeries under general anesthesia. Demographic data of patients, case type, surgery type, duration of anesthesia, intraoperative lactate level, and postoperative complications of patients who underwent nephrectomy in our clinic were reviewed. Renal function was compared with urea, creatinine and estimated glomerular filtration rate (eGFR) levels in the preoperative (2 days before surgery) and postoperative period (day 2). The mean age of the patient was 58.2 ± 13.02 years, duration of anesthesia 166.24 ± 53.01/min, pre-operative eGFR 84.71 (67.69-90.0) mL/min/1.73 m2, and postoperative eGFR 65.09 (47.91-87.44) mL/min/1.73 m2 were respectively. When the pre- and postoperative renal functions of the patients were compared, the statistically significant results were those of urea (p: 0.01), creatinine (p:0.01), and GFR (p:0.01). The factors affecting GFR decrease were age (p:0.01) and case type (p:0.01). Increase in lactate levels in the postoperative period compared to the preoperative levels was statistically significant (p: 0.01). The increase in lactate levels was associated with complications (p: 0.001), case type (p:0.01) and surgery type (p: 0.01). Conclusions: The incidence of acute renal failure is increasing in nephrectomy surgeries, especially in radical ones. Age and case type are also the most important parameters to be consider.
Project Number
yok
References
- 1. Mishra A, Verma R, Bhatia V, et al. Thoracic Paravertebral Block for Postoperative Pain Management in Patients Undergoing for Nephrectomy: A Randomised Clinical Trial. Journal of Clinical & Diagnostic Research. 2018;12(10).
- 2. Lane BR, Babitz SK, Vlasakova K, et al. Evaluation of Urinary Renal Biomarkers for Early Prediction of Acute Kidney Injury Following Partial Nephrectomy: A Feasibility Study. European urology focus. 2020;6:1240-1247.
- 3. Lee HT, Ota-Setlik A, Fu Y, Nasr SH, Emala CW. Differential protective effects of volatile
- anesthetics against renal ischemia–reperfusion injury in vivo. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004;101:1313-24.
- 4. Yildirim M, Kucuk H, Demir T, et al. Early Allograft Function in Renal Transplant Recipients: Is it Affected by Volatile Anesthetics? Transplantation Proceedings; 2015: Elsevier.
- 5. Ko JS, Gwak MS, Choi SJ, et al. The effects of desflurane and sevoflurane on hepatic and renal functions after right hepatectomy in living donors. Transplant International. 2010;23:736-44.
- 6. Gazel E, Biçer S, Ölçücüoğlu E, et al. Comparison of renal function after donor and radical nephrectomy. Renal Failure. 2015;37:377-80.
- 7. Pettus JA, Jang TL, Thompson RH, Yossepowitch O, Kagiwada M, Russo P, editors. Effect of baseline glomerular filtration rate on survival in patients undergoing partial or radical nephrectomy for renal cortical tumors. Mayo Clinic Proceedings; 2008: Elsevier.
- 8. Marini F, Bellugi I, Gambi D, et al. Compound A, formaldehyde and methanol concentrations during low‐flow sevoflurane anaesthesia: comparison of three carbon dioxide absorbers. Acta anaesthesiologica scandinavica. 2007;51:625-32.
- 9. Conzen PF, Kharasch ED, Czerner SF, et al. Low-flow sevoflurane compared with low-flow isoflurane anesthesia in patients with stable renal insufficiency. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2002;97:578-84.
- 10. Fukuda H, Kawamoto M, Yuge O, Fujii K. A comparison of the effects of prolonged (> 10 hour) low-flow sevoflurane, high-flow sevoflurane, and low-flow isoflurane anaesthesia on hepatorenal function in orthopaedic patients. Anaesthesia and intensive care. 2004;32:210-8.
- 11. Cai J, Xu R, Yu X, Fang Y, Ding X. Volatile anesthetics in preventing acute kidney injury after cardiac surgery: a systematic review and meta-analysis. The Journal of thoracic and cardiovascular surgery. 2014;148:3127-36.
- 12. Sindhvananda W, Phisaiphun K, Prapongsena P. No renal protection from volatile-anesthetic preconditioning in open heart surgery. Journal of anesthesia. 2013;27:48-55.
- 13. Kher A, Meldrum KK, Wang M, et al. Cellular and molecular mechanisms of sex differences in renal ischemia–reperfusion injury. Cardiovascular research. 2005;67:594-603.
- 14. Toprak H, Şahin T, Aslan S, et al. editors. Effects of desflurane and isoflurane on hepatic and renal functions and coagulation profile during donor hepatectomy. Transplantation proceedings; 2012: Elsevier.
- 15. Brandina R, Leite KRM, Gregório EP, Fernandes KBP, Srougi M. Histologic abnormalities in non-neoplastic renal parenchyma and the risk of chronic kidney disease following radical nephrectomy. Urology. 2017;100:158-62.
- 16. Yokoyama M, Fujii Y, Iimura Y, et al. Longitudinal change in renal function after radical nephrectomy in Japanese patients with renal cortical tumors. The Journal of urology. 2011;185:2066-71.
- 17. Choi YS, Park YH, Kim Y-J, et al. Predictive factors for the development of chronic renal insufficiency after renal surgery: a multicenter study. International urology and nephrology. 2014;46:681-6.
- 18. Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. American journal of kidney diseases. 2000;36:646-61.
- 19. Duymaz G, Yağar S, Özgök A. Comparison of effects of low-flow sevoflurane and low-flow desflurane anaesthesia on renal functions using cystatin C. Turkish Journal of Anaesthesiology and Reanimation. 2017;45:93.
- 20. Ebert TJ, Arain SR. Renal responses to low-flow desflurane, sevoflurane, and propofol in patients. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000;93:1401-6.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | ORİJİNAL MAKALE |
| Authors | |
| Project Number | yok |
| Publication Date | May 23, 2023 |
| Published in Issue | Year 2023 Volume: 45 Issue: 3 |