Prognostic factors of acute renal failure following partial nephrectomy of solitary kidney

Background. Acute renal failure (ARF) in the postoperative period increases the risk of complications and death. Estimating the risk of ARF prior to surgery is particularly important, because it allows modifying the treatment in high-risk patients.

Objective: to develop prognostic models for evaluating the risks of ARF in patients undergoing resection of a solitary kidney by measuring preoperative parameters.

Materials and methods. The study included 136 patients with tumors in a solitary kidney that underwent surgical treatment in the N.N. Alexandrov National Cancer Center of Belarus in the last 16 years.

Results. Biochemical blood tests demonstrated that 28 patients (20.6 %) had ARF in the early postoperative period. The multivariate model for assessing the risk of ARF included the following three covariates: tumor size, multifocality, and serum potassium level. We identified the cut-off points of tumor size (3.6 and 5.2 cm) and potassium level (4.4 and 4.8 mmol/L) that ensured maximum predictive accuracy. Using the multivariate model, we developed a nomogram that allows graphical calculation of the ARF probability in the postoperative period by measuring preoperative parameters.

Conclusion. Our model enables preoperative assessment of the risk of developing ARF after resection of a solitary kidney with an accuracy (С-index) of 85.1 % (95 % confidence interval: 79.3–89.7 %).

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