尿液中N端腦粒鈉肽前體作為以解決腎水腫為目的之輸尿管鏡手術術後腎功能恢復之非侵入性指標

劉佳旻、劉展榮、黃鶴翔

國立成功大學醫學院附設醫院泌尿部

Urine NT-Probnp as a Non-Invasive Indicator for Recovery of Renal Function after Receiving Ureteroscopic Surgery aiming at Relieving Hydronephrosis

Chia-Min Liu, Chan-Jung Liu, Ho-Shiang Huang

Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Purpose: This prospective case-control study aims to evaluate the changes in renal function as well as levels of NT-proBNP in serum and urine after relief of hydronephrosis by URS surgery. We explored the association between hydronephrosis and cardio-renal syndrome by measuring the change of NT-proBNP and evaluated the merits of using urine NT-proBNP as a fast and easily accessible marker to predict the kidney function recovery after relieving hydronephrosis.
Material and Methods: Patients admitted for surgical interventions to relieve obstructive uropathy via the ureteroscopic procedures, including URSL or ureteroscopic balloon dilatation were enrolled in this prospective study(n=212). Renal sonography to determine the grade of hydronephrosis as well as blood and urine samples to measure creatinine and NT-proBNP level were obtained preoperatively, 1 day and 14 days postoperatively respectively. Univariate and multivariate logistic regression was done to determine the association between parameters and the recovery of renal function after the surgery.

Results: In 212 subjects enrolled for the study, patients with higher grade of hydronephrosis presented poorer renal function as well as significantly lower urine NT-proBNP. After the surgery aiming at hydronephrosis performed, urine NT-proBNP had significantly increased (p < 0.001). For patients whose renal function improves after the surgery, their urine NT-proBNP at baseline was remarkably lower(p =0.002). Moreover, only baseline urine NT-proBNP/Cr was significantly associated with renal function recovery (OR 3.24, 95% CI 1.09-9.70, p=0.035) after adjustment. The ROC analysis was further performed to assess the ability of preoperative urine NT-proBNP/Cr in predicting the improvement of renal function after URS surgery, which showed an area under the ROC curve (AUC) = 0.77 (p < 0.001).

Conclusions: By analyzing the change of NT-proBNP and NGAL after URS procedure aiming at relieving hydronephrosis, we found out that the more severe hydronephrosis was associated with poorer renal function, lower urine NT-proBNP and higher serum NT-proBNP preoperatively which may possibly be explained by cardiorenal syndrome. Moreover, the lower urine NT-proBNP is predictive for the improvement of renal function after the surgery. Our findings suggest that the urinary NT-prBNP may be useful as an early marker of renal function recovery after URS surgery.