Perioperative acute kidney injury in surgical treatment of renal cancer: pathogenesis, therapy of early and late complications

The development of acute renal injury is due to a number of factors both on the part of the patient (age, concomitant pathology, objective status) and the oncological process (stage of the disease, localization, volume of surgical intervention, access, etc.). Acute renal injury in patients with kidney cancer after surgical treatment may be accompanied by the development of early (hyperhydration, electrolyte balance disorders, hyperkalemia, acid‑base condition disorders, uremic intoxication) and late chronic kidney disease complications. The incidence of these complications increases with an increase in the volume of kidney resection, as a result of which it is important to take into account risk factors, timely diagnosis of the degree of kidney damage and medical measures aimed at restoring kidney function. Currently, the possibility of using various molecules as early markers of kidney damage, which help not only assess the presence of kidney damage, but also localize it, is being studied. For example, albumin, serum cystatin C, alpha 1‑microglobulin, P2‑microglobulin – markers of glomerular damage, NGAL, KIM‑1; L‑FABP, urine cystatin‑C, IL‑18 – reflect damage to the proximal tubule, GST, NGAL – distal tubule, calibindin D28 ‑ characterizes damage to the collecting duct, osteopontin, NHE‑3 – are associated with damage to the loop of Henle. Measures of a curative and preventive nature (infusion therapy, anti‑ischemic protection, modulation of ferroptosis, renal replacement therapy), as well as dynamic monitoring of the main biomarkers of renal damage are aimed at preventing the persistence of the pathological process with a possible outcome into chronic kidney disease, which is especially undesirable in patients with single kidney cancer. The main directions of medical and preventive measures in patients with acute kidney injury should be considered: 1) the fastest possible elimination or minimization of the effect of tumor tissue; 2) control and correction of life‑threatening complications of renal dysfunction (hyperhydration, electrolyte balance disorders (hyperkalemia), acid‑base state, uremic intoxication). Methods of anti‑ischemic protection include a number of surgical techniques aimed at 1) minimizing ischemia time, 2) reducing the intensity of volatile metabolic processes in the kidney, 3) training renal parenchyma for hypoxic conditions (receiving ischemic preconditioning).

Duration of renal ischemia represents an important modifiable factor affecting early and distant renal function in surgically exposed patients. The article analyzes modern scientific data on the problem of postoperative acute kidney injury in renal cancer surgery.

1. Du Z, Chen W, Xia Q, Shi O, Chen Q. Trends and projections of kidney cancer incidence at the global and national levels, 1990-2030: a Bayesian age-period-cohort modeling study. Biomark Res. 2020 May 13;8:16. https://doi.org/10.1186/s40364-020-00195-3

2. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract. 2013;2013:479730. https://doi.org/10.1155/2013/479730

3. Padala SA, Barsouk A, Thandra KC, Saginala K, Mohammed A, Vakiti A, et al. Epidemiology of Renal Cell Carcinoma. World J Oncol. 2020;11(3):79–87. https://doi.org/10.14740/wjon1279

4. Farooqi S, Dickhout JG. Major comorbid disease processes associated with increased incidence of acute kidney injury. World J Nephrol. 2016 Mar 6;5(2):139–146. https://doi.org/10.5527/wjn.v5.i2.139

5. Rosner MH, Perazella MA. Acute kidney injury in the patient with cancer. Kidney Res Clin Pract. 2019 Sep 30;38(3):295–308. https://doi.org/10.23876/j.krcp.19.042

6. Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ. Acute kidney injury. Nat Rev Dis Primers. 2021;7(1):52. https://doi.org/10.1038/s41572-021-00284-z

7. Sundström J, Bodegard J, Bollmann A, Vervloet MG, Mark PB, Karasik A, et al.; CaReMe CKD Investigators. Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: The CaReMe CKD study. Lancet Reg Health Eur. 2022 Jun 30;20:100438. https://doi.org/10.1016/j.lanepe.2022.100438

8. Kulchenko NG. Treatment of localized renal cancer. South Russian Journal of Cancer. 2020;1(1):69–75. (In Russ.). https://doi.org/10.37748/2687-0533-2020-1-1-6

9. Shevchenko AN, Breus AA, Neskubina IV, Dzhenkova EA, Filatova EV, Shvyrev DA. Evaluation of the prognostic significance of some biological factors in local and generalized clear cell renal cancer. South Russian Journal of Cancer. 2020;1(1):6–22. (In Russ.). https://doi.org/10.37748/2687-0533-2020-1-1-1

10. Dimitriadi SN, Ushakova ND, Velichko AV, Frantsiyants EM. Evaluation of the corrective effect of therapeutic plasmapheresis on the state of renal function in patients after surgical treatment of localized kidney cancer. South Russian Journal of Cancer. 2021;2(2):6–14. (In Russ.). https://doi.org/10.37748/2686-9039-2021-2-2-1

11. Sokolov DV, Polushin YS. Acute renal injury in the peri-operative period. Messenger of Anesthesiology and Resuscitation. 2018;15(1):46–54

12. Burne-Taney MJ, Liu M, Ascon D, Molls RR, Racusen L, Rabb H. Transfer of lymphocytes from mice with renal ischemia can induce albuminuria in naive mice: a possible mechanism linking early injury and progressive renal disease? Am J Physiol Renal Physiol. 2006;291(5):F981-6. https://doi.org/10.1152/ajprenal.00229.2005

13. Popov SV, Guseinov RG, Skryabin ON, Sivak KV. Thermal ischemia of the kidney. Мoscow, 2021. (In Russ.).

14. Mitsiev AK. Change lipid peroxidation as a mechanism of renal disease under heavy metals. Pathological physiology and experimental therapy. 2015;2:72–76. (In Russ.).

15. Balzer MS, Doke T, Yang YW, Aldridge DL, Hu H, Mai H, et al. Single-cell analysis highlights differences in druggable pathways underlying adaptive or fibrotic kidney regeneration. Nat Commun. 2022 Jul 11;13(1):4018. https://doi.org/10.1038/s41467-022-31772-9

16. Liu Y, Wang J. Ferroptosis, a Rising Force against Renal Fibrosis. Oxid Med Cell Longev. 2022 Oct 12;2022:7686956. https://doi.org/10.1155/2022/7686956

17. Zhou RP, Chen Y, Wei X, Yu B, Xiong ZG, Lu C, et al. Novel insights into ferroptosis: Implications for age-related diseases. Theranostics. 2020;10(26):11976–11997. https://doi.org/10.7150/thno.50663

18. Timerbulatov ShV, Timerbulatov MV, Sultanbaev AU. Reperfusion syndrome in abdominal surgery. Bashkortostan Medical Journal. 2010;5(4):145–151. (In Russ.).

19. Cho A, Lee JE, Kwon GY, Huh W, Lee HM, Kim YG, Kim DJ, Oh HY, Choi HY. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transplant. 2011 Nov;26(11):3496–3501. https://doi.org/10.1093/ndt/gfr094

20. Lameire N, Vanholder R, Van Biesen W, Benoit D. Acute kidney injury in critically ill cancer patients: an update. Crit Care. 2016 Aug 2;20(1):209. https://doi.org/10.1186/s13054-016-1382-6

21. Grams ME, Sang Y, Coresh J, Ballew S, Matsushita K, Molnar MZ, et al. Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data. Am J Kidney Dis. 2016;67(6):872–880. https://doi.org/10.1053/j.ajkd.2015.07.022

22. Meersch M, Schmidt C, Zarbock A. Perioperative Acute Kidney Injury: An Under-Recognized Problem. Anesth Analg. 2017;125(4):1223–1232. https://doi.org/10.1213/ane.0000000000002369

23. Djordjevic A, Susak S, Velicki L, Antonic M. Acute Kidney Injury after Open-Heart Surgery Procedures. Acta Clin Croat. 2021;60(1):120–126. https://doi.org/10.20471/acc.2021.60.01.17

24. Antonelli A, Allinovi M, Cocci A, Russo GI, Schiavina R, Rocco B, et al. The Predictive Role of Biomarkers for the Detection of Acute Kidney Injury After Partial or Radical Nephrectomy: A Systematic Review of the Literature. Eur Urol Focus. 2020;6(2):344–353. https://doi.org/10.1016/j.euf.2018.09.020

25. Martini A, Sfakianos JP, Paulucci DJ, Abaza R, Eun DD, Bhandari A, et al. Predicting acute kidney injury after robot-assisted partial nephrectomy: Implications for patient selection and postoperative management. Urol Oncol. 2019 Jul;37(7):445–451. https://doi.org/10.1016/j.urolonc.2019.04.018

26. Wu Y, Chen J, Luo C, Chen L, Huang B. Predicting the risk of postoperative acute kidney injury: development and assessment of a novel predictive nomogram. J Int Med Res. 2021 Aug;49(8):3000605211032838. https://doi.org/10.1177/03000605211032838

27. Matveev VB. Clinical oncourology. Мoscow, 2011. (In Russ.).

28. Mosoyan M, Rumyantsev A, Esayan A, Zemchenkov A. Long-term results of open, laparoscopic, and robot-assisted partial nephrectomy. Vrach (The Doctor). 2017;28(11):79–82. (In Russ.).

29. Smirnov AV, Rumyantsev AS. Acute kidney disease. Part I. Nephrology (Saint-Petersburg). 2020;24(1):67–95. (In Russ.). https://doi.org/10.36485/1561-6274-2020-24-1-67-95

30. Arthur JM, Hill EG, Alge JL, Lewis EC, Neely BA, Janech MG, et al. Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery. Kidney Int. 2014;85(2):431–438. https://doi.org/10.1038/ki.2013.333

31. Smirnowa NN, Galkina OV, Novikova VP, Prokopyeva NE. Modern biomarkers of renal damage in pediatrics. Nephrology (Saint-Petersburg). 2019;23(4):112–118. (In Russ.). https://doi.org/10.24884/1561-6274-2019-23-4-112-118

32. Vijayan A, Faubel S, Askenazi DJ, Cerda J, Fissell WH, Heung M, et al. American Society of Nephrology Acute Kidney Injury Advisory G. Clinical Use of the Urine Biomarker [TIMP-2] x [IGFBP7] for Acute Kidney Injury Risk Assessment. Am J Kidney Dis. 2016;68(1):19–28. https://doi.org/10.1053/j.ajkd.2015.12.033

33. Dimitriadi SN, Frantsiyants EM, Ushakova ND, Rozenko DA, Velichko AV. Biomarkers in diagnostics of acute kidney injury after the organ-preserving surgery of localized renal cancer. Medical Herald of the South of Russia. 2018;9(3):77–83. (In Russ.). https://doi.org/10.21886/2219-8075-2018-9-3-77-83.

34. Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A, Group NM. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;54(6):1012–1024. https://doi.org/10.1053/j.ajkd.2009.07.020

35. Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol. 2014;10(1):37–47. https://doi.org/10.1038/nrneph.2013.232

36. Raimundo M, Crichton S, Martin JR, Syed Y, Varrier M, Wyncoll D, et al. Increased Fluid Administration After Early Acute Kidney Injury is Associated with Less Renal Recovery. Shock. 2015;44(5):431–437. https://doi.org/10.1097/shk.0000000000000453

37. Kit OI, Frantsiyants EM, Dimitriadi SN, Kaplieva IV, Trepitaki LK, Cheryarina ND, Pogorelova YuA. Role of markers for acute kidney injury in surgical management of patients with renal cancer. Cancer Urology. 2015;11(3):34–39. (In Russ.). https://doi.org/10.17650/1726-9776-2015-11-3-34-39

38. Eggener SE, Clark MA, Shikanov S, Smith B, Kaag M, Russo P, et al. Impact of warm versus cold ischemia on renal function following partial nephrectomy. World J Urol. 2015 Mar;33(3):351–357. https://doi.org/10.1007/s00345-014-1315-4

39. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009 Sep;182(3):844–853. https://doi.org/10.1016/j.juro.2009.05.035

40. Motzer RJ, Jonasch E, Agarwal N, Beard C, Bhayani S, Bolger GB et al. National comprehensive cancer n. Kidney cancer, version 3. 2015. J Natl Compr Canc Netw. 2015;13(2):151–159. https://doi.org/10.6004/jnccn.2015.0022