目的:单纯性肾囊肿,这是常见的,通常被认为是有限的临床相关性,与年龄较大和肾小球滤过率(GFR)较低有关,但对它们与进行性慢性肾脏病(CKD)的相关性知之甚少.
方法:观察性队列研究。
方法:接受根治性肾切除术的术前计算机断层扫描或磁共振成像的患者;我们回顾了保留的肾脏图像,以根据大小和位置描述直径至少为5mm的实质囊肿。
方法:保留的肾脏中直径至少5mm的实质囊肿。囊肿特征与肾脏组织学的微结构发现相关。
结果:由透析定义的进行性CKD,肾移植,eGFR持续≥40%下降至少3个月,或eGFR<10mL/min/1.73m2,比肾切除术后基线低至少5mL/min/1.73m2,持续至少3个月。
方法:Cox模型评估进行性CKD的风险。根据基线年龄调整的模型,性别,身体质量指数,高血压,糖尿病,eGFR,蛋白尿,和肿瘤体积。非参数Spearman相关性用于检查囊肿的数量和大小与临床特征的关联。肾功能,和肾脏体积。
结果:在中位4.4年的随访评估中,有1,195例患者发生50例进行性CKD事件。在基线成像时,38%至少有1个囊肿,34%有至少1个皮质囊肿,8.7%至少有1个髓样囊肿。较高数量的囊肿与进行性CKD相关,并且与肾脏组织学上较大的肾单位和更多的肾硬化相关。与皮质囊肿的数量相比,髓质囊肿的数量与进行性CKD的相关性更强。
结论:接受根治性肾切除术的患者可能与普通人群不同。根治性肾切除术可能会加速进行性CKD的风险。未进行基因检测。
结论:肾囊肿,尤其是髓质,除了目前对肾功能和常见CKD危险因素的临床评估外,还应进一步检查作为进行性CKD的潜在有用成像生物标志物。
肾囊肿是常见的,尽管与较低的肾小球滤过率相关,但通常被认为具有有限的临床相关性。我们研究了一大群因肿瘤切除肾脏的患者,以确定保留的肾脏中的囊肿是否与未来的肾脏健康相关。我们发现肾脏有更多的囊肿,特别是,肾脏最深组织(髓质)的囊肿与进行性肾脏疾病有关,包括需要透析或肾移植的肾衰竭。肾髓质囊肿患者可能受益于密切监测。
Simple kidney cysts, which are common and usually considered of limited clinical relevance, are associated with older age and lower glomerular filtration rate (GFR), but little has been known of their association with progressive chronic kidney disease (CKD).
Observational cohort study.
Patients with presurgical computed tomography or magnetic resonance imaging who underwent a radical nephrectomy for a tumor; we reviewed the retained kidney images to characterize parenchymal cysts at least 5mm in diameter according to size and location.
Parenchymal cysts at least 5mm in diameter in the retained kidney. Cyst characteristics were correlated with microstructural findings on kidney histology.
Progressive CKD defined by dialysis, kidney transplantation, a sustained≥40% decline in eGFR for at least 3 months, or an eGFR<10mL/min/1.73m2 that was at least 5mL/min/1.73m2 below the postnephrectomy baseline for at least 3 months.
Cox models assessed the risk of progressive CKD. Models adjusted for baseline age, sex, body mass index, hypertension, diabetes, eGFR, proteinuria, and tumor volume. Nonparametric Spearman\'s correlations were used to examine the association of the number and size of the cysts with clinical characteristics, kidney function, and kidney volumes.
There were 1,195 patients with 50 progressive CKD events over a median 4.4 years of follow-up evaluation. On baseline imaging, 38% had at least 1 cyst, 34% had at least 1 cortical cyst, and 8.7% had at least 1 medullary cyst. A higher number of cysts was associated with progressive CKD and was modestly correlated with larger nephrons and more nephrosclerosis on kidney histology. The number of medullary cysts was more strongly associated with progressive CKD than the number of cortical cysts.
Patients who undergo a radical nephrectomy may differ from the general population. A radical nephrectomy may accelerate the risk of progressive CKD. Genetic testing was not performed.
Cysts in the kidney, particularly the medulla, should be further examined as a potentially useful imaging biomarker of progressive CKD beyond the current clinical evaluation of kidney function and common CKD risk factors.
Kidney cysts are common and often are considered of limited clinical relevance despite being associated with lower glomerular filtration rate. We studied a large cohort of patients who had a kidney removed due to a tumor to determine whether cysts in the retained kidney were associated with kidney health in the future. We found that more cysts in the kidney and, in particular, cysts in the deepest tissue of the kidney (the medulla) were associated with progressive kidney disease, including kidney failure where dialysis or a kidney transplantation is needed. Patients with cysts in the kidney medulla may benefit from closer monitoring.