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<p>Ischemia-reperfusion injury during partial nephrectomy often causes postoperative acute kidney injury (AKI). The clinical significance of renal NR4A1 in human ischemic AKI remains unclear. In this prospective cohort study, 104 patients with localized renal cell carcinoma were enrolled, including 72 undergoing partial nephrectomy and 32 radical nephrectomy controls. Renal NR4A1 and phosphorylated β-catenin (p-β-catenin) expression were assessed by immunohistochemistry and Western blot. Tubular injury, apoptosis, renal function, and AKI biomarkers were evaluated up to 12 months postoperatively. NR4A1 expression was significantly increased in partial nephrectomy tissue, while p-β-catenin was reduced (both <i>P</i> &lt; 0.001). NR4A1 correlated positively with tubular injury, apoptosis, and peak serum creatinine, and negatively with p-β-catenin (all <i>P</i> &lt; 0.001). Patients with incomplete renal recovery had significantly higher NR4A1 expression. Multivariable analysis identified NR4A1 as an independent predictor of incomplete recovery (adjusted OR = 3.27, <i>P</i> = 0.003), with an AUC of 0.801. Elevated renal NR4A1 is associated with more severe ischemic injury and poorer renal recovery after partial nephrectomy.</p>

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Renal NR4A1 predicts ischemic AKI severity and recovery after partial nephrectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Wenjian Shi,
  • Jing Dong,
  • Xi Fang,
  • Qinghua Zeng,
  • Jun Tan,
  • Kanghan Liu

摘要

Ischemia-reperfusion injury during partial nephrectomy often causes postoperative acute kidney injury (AKI). The clinical significance of renal NR4A1 in human ischemic AKI remains unclear. In this prospective cohort study, 104 patients with localized renal cell carcinoma were enrolled, including 72 undergoing partial nephrectomy and 32 radical nephrectomy controls. Renal NR4A1 and phosphorylated β-catenin (p-β-catenin) expression were assessed by immunohistochemistry and Western blot. Tubular injury, apoptosis, renal function, and AKI biomarkers were evaluated up to 12 months postoperatively. NR4A1 expression was significantly increased in partial nephrectomy tissue, while p-β-catenin was reduced (both P < 0.001). NR4A1 correlated positively with tubular injury, apoptosis, and peak serum creatinine, and negatively with p-β-catenin (all P < 0.001). Patients with incomplete renal recovery had significantly higher NR4A1 expression. Multivariable analysis identified NR4A1 as an independent predictor of incomplete recovery (adjusted OR = 3.27, P = 0.003), with an AUC of 0.801. Elevated renal NR4A1 is associated with more severe ischemic injury and poorer renal recovery after partial nephrectomy.