ABSTRACT
In patients with a solitary kidney; residual renal volume is an important prognostic factor for kidney survival. At present, the impact of renal cysts on solitary kidney survival is not clear. The aim of this study is to examine the association of cysts on progression of renal failure in patients with a solitary kidney. METHODS: This study included sixtyfive solitary kidney patients. The remaining kidneys after indication nephrectomy (IN) were evaluated with urinary system ultrasound. The primary outcome of the study is the progression of kidney failure during follow-up which was defined as: 25% decrease in glomerular filtration rate (GFR) and / or the need for renal replacement therapy (RRT). RESULTS: The mean age of the patients was 55 ± 14 years and mean follow-up was 53 ± 27 months. Renal cysts were present in 30.7% of patients. 33.8 percent of patients had kidney disease progression and 10.7 % required RRT. Those with progressive disease were older (61 ± 13, 52 ± 14; P = 0.011), had lower baseline GFR (30 ± 11, 39 ± 18; P = 0.035), higher proteiuria (2.84 ± 0.58, 2.47 ± 0.57; P = 0.031) and frequently harboring cysts in the solitary kidney (52.3%, 20.4%; P = 0.006). Progression to kidney failure and RRT requirement in cases with or without renal cysts was (60% vs. 22%; P = 0.004) and (20% vs. 6.6%; P = 0.123), respectively. Acquired cysts in solitary kidney was independently associated with progression to kidney failure and RRT respectively (Exp(B) 3.173; P = 0.01 and Exp(B) 12.35; P = 0.04). CONCLUSION: Simple renal cysts in solitary kidney patients with impaired renal function is associated with poor renal outcome. Large-scale studies are needed to clarify this issue.
Subject(s)
Glomerular Filtration Rate , Kidney Diseases, Cystic/complications , Kidney/physiopathology , Nephrectomy/adverse effects , Renal Insufficiency, Chronic/etiology , Renal Insufficiency/etiology , Adult , Aged , Disease Progression , Female , Humans , Kidney/diagnostic imaging , Kidney Diseases, Cystic/diagnosis , Kidney Diseases, Cystic/physiopathology , Kidney Diseases, Cystic/therapy , Longitudinal Studies , Male , Middle Aged , Renal Insufficiency/diagnosis , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy , Retrospective Studies , Risk Factors , Time Factors , UltrasonographyABSTRACT
OBJECTIVE: The purpose of this study was to investigate the association of the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with the clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease (CKD). MATERIAL AND METHODS: A total of 165 patients over the age of 65, with stage 3-5 CKD, were enrolled in the study. The primary endpoints were all-cause of deaths and requirement of renal replacement therapy. The patients were divided into two groups according to delta neutrophil/lymphocyte ratio such as increased (group 1) and decreased or stable (group 2) groups. RESULTS: The mean age was 73.8 ± 6.1 years and the mean follow-up was 30 ± 13 months. Thirty-one (18.7%) patients died during the follow-up period and 21 (13.4%) patients required renal replacement therapy. The neutrophil/lymphocyte ratio increased in 95 (57.5%) patients. The mortality rate (24.2%, 11.4%; p = 0.03) and requirement of renal replacement therapy (19.1%, 5.7%; p = 0.01) were higher in group 1 compared to group 2. In the Cox regression analysis, the basal neutrophil/lymphocyte ratio was the independent predictor of death (HR: 1.23 (95% CI 1.02-1.47), p = 0.02), and the basal eGFR was the independent predictor of requirement of renal replacement therapy (HR:0.938, 95% CI: 0.888-0.991, p = 0.02). However, platelet/lymphocyte ratio was not associated with death and requirement of renal replacement therapy independently. CONCLUSION: The neutrophil/lymphocyte ratio predicts all-cause of mortality in geriatric patients with chronic kidney disease.
