Selected Blood Biochemical Parameters after Right and Left Nephrectomy in Clinical Practice

Introduction. Radical nephrectomy is considered as a common operation associated with significant changes in the topography of the upper abdominal cavity which appear in the postoperative period. Analysis of the literature fails to provide sufficient information about functional changes in the parenchymatous abdominal organs that occur after nephrectomy. Aim. To investigate a number of liver and pancreatic enzymes in the blood of patients at the pre­ and post­ operative stages of the radical nephrectomy. Materials and methods. The study involved a retrospective analysis of medical records of 111 patients after radical nephrectomy. The patients underwent biochemical examination at the pre­operative stage, on day 1, and day 7 after the operation: ALT, AST, amylase, diastase. The examination was performed by means of biochemistry analyzers Bio Systems BA 400 and Beckman Coulter AU 480. Statistical data processing was carried out using Statistica 10.0. Results. The analysis of the obtained materials shows that the level of liver and pancreatic enzymes increases after radical nephrectomy. A side of the operation was revealed significant: left­sided nephrectomy leads to an increase in the level of blood amylase and diastase, right­sided nephrectomy results in an increase in the level of ALT and AST. No dependence on the sex of patients was determined. No increase in the level of the studied enzymes was found in a number of patients in the postoperative period; however, almost half of patients were detected with a significant, 1.5–2 times and higher, increase in the level of enzymes, thus requiring special control and correction. The maximum level of ALT reached 245 U/L (norm 0–35 U/L), the maximum level of AST comprised 184 IU/L (norm 0–35 IU/L). Discussion. The obtained results indicate the interrelation of functional disorders of the liver and pancreas and changes in their topography after radical nephrectomy. Conclusion. Radical nephrectomy is associated with significant functional disorders of the liver and pancreas depending on the side of the operation: the level of blood amylase and diastase increases after left nephrectomy, the level of ALT and AST grows after right nephrectomy. The level of enzymes exceeds the norm by 1.5–2 times in almost half of patients.

1. Siegel R.L., Mitter K.D., Jemal A. Cancer statistics, 2019. CA cancer J Clin. 2019;69(1):7–34. DOI: 10.3322/caac.21551

2. Aksel E.M., Matveev V.B. Statistics of malignant neoplasms of the urinary and male genital organs in Russia and the countries of the former USSR. Oncourology. 2019;15(2):15–24 (In Russ.). DOI: 10.17650/1726-9776-2019-15-2-15-24

3. Kadyrov Z.A., Odilov A.Yu., Yagudaev D.M. Comparative analysis of intra- and postoperative complications of retroperitoneoscopic and laparoscopic nephrectomy in large tumors. Oncourology. 2018;14(4):22–8 (In Russ.). DOI: 10.17650/1726-9776-2018-14-4-22-28

4. Kadyrov Z.A., Odilov A.Yu. Complications of traditional, laparoscopic and retroperitoneoscopic nephrectomy in various kidney diseases. Urology. 2020;4:151–6 (In Russ.). DOI: 10.18565/urology.2020.4.151-156

5. Safronova Yu. V., Chemezov S. V. Topographic and anatomical changes in the ascending and descending colon in kidney cancer and after nephrectomy. Morphology. 2020;157(2–3):187–8 (In Russ.).

6. Chemezov S.V., Safronova Yu.V. Regularities of changes in the topography of the abdomen in kidney tumors and after nephrectomy. Bulletin of the Military Medical Academy. 2017;19(S3):157–8 (In Russ.).

7. Clayman R.V., Kavoussi L.R., Soper N.J., Dierks S.M., Meretyk S., Darcy M.D., et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146(2):278–82. DOI: 10.1016/s0022-5347(17)37770-4

8. Kagan I.I. Topographic and anatomical changes after resection and removal of internal organs as a problem and an integral part of modern clinical anatomy Morphological Newsletter. 2017;25(1):6–9 (In Russ.). DOI: 10.20340/mv-mn.17(25).01.01

9. Monina Yu.V., Chemezov S.V. Features of computer-tomogpaphic anatomy of retroperitoneal space after nephrectomies. Creative surgery and oncology. 2014;3:52–4 (In Russ.). DOI: 10.24060/2076-3093-2014-0-3-52-54

10. Giannini E.G., Testa R., Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005;172(3):367–79. DOI: 10.1503/cmaj.1040752

11. Forbes A., Misiewicz J.J., Compton C.C., Levine M.S., Quraishy M. Sh., Rubesin S.E., et al. (eds) Atlas of Clinical Gastroenterology. Elsevier; 2005.

12. Dominguez-Munoz J.E. (ed.) Clinical pancreatology for practicing gastroenterologists and surgeons. Blackwell Publishing Company; 2005.

13. Siegmund E., Löhr J.M., Schuff-Werner P. The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis. Z Gastroenterol. 2004;42(10):1117–28 (In German). DOI: 10.1055/s-2004-813604

14. Issa Y., van Santvoort H.C., van Dieren S., Besselink M.G., Boermeester M.A., Ahmed Ali U. Diagnosing chronic pancreatitis: comparison and evaluation of different diagnostic tools. pancreas. 2017;46(9):1158–64. DOI: 10.1097/MPA.0000000000000903

15. Beger H.G., Warshaw A.L., Hruban R.H., Buchler M.W., Lerch M.M., Neoptolemos J.P., et al. The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery. Oxford: Willey Blackwell; 2018.

16. Adams D.B., Cotton P.B, Zyromski N.J., Windsor J.A. Pancreatitis: Medical and Surgical Management. Chichester: Wiley Blackwell; 2017.