Preoperative proteinuria as a novel biomarker for predicting postoperative renal insufficiency after nephrectomy for renal cell carcinoma: a systematic review and meta-analysis.

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Irish Journal of Medical Science Pub Date : 2025-06-18 DOI:10.1007/s11845-025-03987-4

Qiankun Xu, Huilan Zheng, Fanchao Zeng, Bin Li, Deliang Huang, Qiang Cai, Zhizhao Yang, Peng Wu

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引用次数: 0

Abstract

Background: Identifying reliable predictors of postoperative renal insufficiency (PRI) following partial or radical nephrectomy for renal cell carcinoma (RCC) is critical for optimizing perioperative management.

Methods: We systematically searched MEDLINE, Cochrane Library, and Embase up to March 20, 2025, to identify cohort studies that evaluated the association between preoperative proteinuria and PRI. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses were stratified by study design (prospective vs. retrospective) and surgical modality (partial vs. radical nephrectomy).

Results: Six cohort studies involving 3124 patients were included. Preoperative proteinuria was significantly associated with an increased risk of PRI (OR = 2.69, 95% CI 1.48-4.89; I² = 67.3%). We found that retrospective studies showed a stronger association between preoperative proteinuria and PRI (OR = 3.35, 95% CI 1.71-6.56) compared to prospective studies (OR = 1.89, 95% CI 0.98-3.66). Subgroup analysis by surgical approach revealed significant risk elevation in both partial nephrectomy (OR = 2.11, 95% CI 1.34-3.33) and radical nephrectomy cohorts (OR = 5.50, 95% CI 4.31-7.02), with a notably higher effect size in the latter.

Conclusion: Preoperative proteinuria is significantly associated with an elevated risk of PRI in patients undergoing nephrectomy for renal cell carcinoma. These findings emphasize the need to incorporate proteinuria assessment into preoperative risk evaluations to improve patient counselling and perioperative management. Future high-quality prospective studies, particularly multicenter investigations with standardized protocols, are essential to confirm these associations and explore the pathophysiological mechanisms underlying proteinuria-related renal functional decline.

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术前蛋白尿作为预测肾细胞癌肾切除术后肾功能不全的新生物标志物：一项系统综述和荟萃分析

背景：确定肾细胞癌（RCC）部分或根治性肾切除术后肾功能不全（PRI）的可靠预测因素对于优化围手术期管理至关重要。方法：我们系统地检索MEDLINE、Cochrane Library和Embase，检索到2025年3月20日，以确定评估术前蛋白尿和PRI之间关系的队列研究，并使用随机效应模型计算合并优势比（ORs）和95%置信区间（CIs）。亚组分析按研究设计（前瞻性与回顾性）和手术方式（部分或根治性肾切除术）进行分层。结果：纳入了6项队列研究，涉及3124例患者。术前蛋白尿与PRI风险增加显著相关(OR = 2.69, 95% CI 1.48-4.89；i2 = 67.3%)。我们发现回顾性研究显示术前蛋白尿和PRI之间的相关性（OR = 3.35, 95% CI 1.71-6.56）比前瞻性研究（OR = 1.89, 95% CI 0.98-3.66）更强。手术入路的亚组分析显示，部分肾切除术（OR = 2.11, 95% CI 1.34-3.33）和根治性肾切除术（OR = 5.50, 95% CI 4.31-7.02）的风险均显著升高，后者的效应量明显更高。结论：术前蛋白尿与肾细胞癌患者行肾切除术后PRI风险升高显著相关。这些发现强调需要将蛋白尿评估纳入术前风险评估，以改善患者咨询和围手术期管理。未来高质量的前瞻性研究，特别是标准化方案的多中心调查，对于确认这些关联和探索蛋白尿相关肾功能下降的病理生理机制至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Irish Journal of Medical Science 医学-医学：内科

CiteScore

3.70

自引率

4.80%

发文量

357

审稿时长

4-8 weeks

期刊介绍： The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker. The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.