Table 3.
Effects of nephrectomy (Nx) on patients with large proteinuriaa
| Procedure | Variable and unitsb | Number of patientsc | Pre-Nxd | Post-Nx | Improved pre-/post-Nxd | Percentage differencee |
|---|---|---|---|---|---|---|
| Median (range) | ||||||
| Unilateral nephrectomy | Proteinuriaa [<4 mg/m2/h] | 9 | 157 (38–329) | 100 (19–213) | 0.11/0.13 | −40* (−18 to −63) |
| Serum albumin [31–48 g/l] | 9 | 34 (20–41) | 36 (29–41) | 0.78/0.88 | +6.0 (−3 to +75) | |
| Total serum protein [61–80 g/l] | 9 | 63 (47–69) | 67 (56–72) | 0.67/0.63 | +3.3 (−6 to +40) | |
| Plasma fibrinogen [1.5–4.0 g/l] | 9 | 4.39 (3.20–7.95) | 4.89 (3.02–6.57) | 0.44/0.13 | −1.3 (+28 to −49) | |
| Bilateral nephrectomy (first stage) | Proteinuria [<4 mg/m2/h] | 3 | 293 (79–305) | 233 (36–280) | 0.00/0.33 | −21 (−8 to −54) |
| Serum albumin [31–48 g/l] | 4 | 23 (10–39) | 22 (13–43) | 0.50/0.50 | +14 (−11 to +30) | |
| Total serum protein [61–80 g/l] | 2 | 50 (37, 63) | 56 (38, 74) | 0.50/0.50 | +10 (3–17) | |
| Plasma fibrinogen [1.5–4.0 g/l] | 2 | 6.47 (3.74, 9.20) | 5.45 (3.64, 7.26) | 0.50/0.50 | −12 (−3 to −21) | |
| Bilateral nephrectomy (rendered anuric)f | Proteinuria [<4 mg/m2/h] | 15 | 322 (100–659) | 0 | 0.00/– | N/A |
| Serum albumin [31–48 g/l] | 15 | 25 (10–33) | 36 (28–43) | 0.13/0.93 | +33** (3–260) | |
| Total serum protein [61–80 g/l] | 15 | 51 (34–59) | 62 (55–77) | 0.00/0.73 | +17** (7–52) | |
| Plasma fibrinogen [1.5–4.0 g/l] | 14 | 6.15 (3.97–16.35) | 3.99 (2.58–5.77) | 0.07/0.55 | −42** (−18 to −71) | |
*p < 0.05, ** < 0.005
N/A, not applicable
aLarge proteinuria is defined as the excretion of >40 mg/m2 per hour (normal <4 mg/m2/h). In some cases, nephrectomy was performed for other indications than (large) proteinuria
bVariables reflect last documented measurements and urine collections prior to and at least 2 (up to 8) weeks post-Nx (see Material and methods). Some patients also presented polyuria or other conditions leading to nephrectomy (see Table 1). Decisions were based on a combination of psychosocial and medical factors, and previous laboratory data (preceding immediate pre-operative measurements). Reference ranges are given in square brackets
cNumber of patients with available measurements for each biomarker
dFraction of patients with urine protein excretion below the nephrotic threshold of 40 mg/m2/h, and with serum protein measurements within reference ranges, respectively, pre- and post-Nx
eWilcoxon matched-pairs signed-rank test. Results are presented as the median, with the range in parenthesis
fBilateral synchronous (n = 12) and staged bilateral nephrectomies (pre 1st/post 2nd stage measurements; n = 3)