Cancer - Kidney(구연) MP Session Ⅰ (MP-002) Geumkang Hall (Avenue 2F) 11월 28일(수) 16:00-17:00 근치적 신장 절제술 후 신장 기능 보상에 수술 전 예측한 잔여 신장 기능이 미치는 영향 울산대학교 의과대학 강릉아산병원 비뇨의학교실 이종필,박창후,김륜한,김성진,김한권,박종연 Objective In this study, we aimed to investigate effects of estimated postoperative remaining renal function of remaining kidney on the compensatory increase of its function after radical nephrectomy. Methods We retrospectively reviewed 79 patients who underwent radical nephrectomy. For each patient, preoperative 99m-Tc DTPA renal scan was done. Pre- and 24-months postoperative serum creatinine were checked. Preoperative function of remaining kidney was calculated using functional percentage of remaining kidney acquired by DTPA renal scan and preoperative eGFR by MDRD equation (Calculated Remaining eGFR, CR-eGFR). Factors affecting postoperative renal functions including CR-eGFR and GFR of remaining kidney on DTPA renal scan (DTPAR-GFR) were analyzed with univariate and multivariate logistic regression analysis. Results Postoperative eGFR after 24 months (51.08±19.26 ml/min/1.73m2) exceeded CR-eGFR (35.82±11.0 ml/min/1.73m2) with p-value <0.001. Median increase of GFR compared to CR-eGFR was 40%. Functional increase of remaining kidney was higher when CR-eGFR and DTPAR-GFR was <35 ml/min/1.73m2(71% vs 26%, p=0.001 and 62% vs 31%, p-value=0.017, respectively). Univariate logistic regression analysis showed positive association with more than 40% increase in GFR with open surgery(p=0.021), DTPA GFR of removed kidney <32.3 ml/min/1.73m2 (p=0.034) and CR-eGFR <35.0 ml/min/1.73m2 (p=0.001). DTPAR-GFR did not show significant correlation(p=0.328), while multivariate analysis showed positive association with open surgery(p=0.010) and CR-eGFR <35.0 ml/min/1.73m2(p=0.002). Conclusions The renal function at 24 months after radical nephrectomy exceeded the calculated remaining eGFR by 40% in this cohort. The function compensation was significantly higher in patients with open surgery and calculated remaining eGFR <35.0 ml/min/1.73m2. These results are especially useful for consulting patients with diminished renal function or patients at risk of postoperative hemodialysis. keywords : Nephrectomy,Compensation,GFR