Diego Aguilar Palacios1, Elvis R Caraballo1, Hajime Tanaka1,2, Yanbo Wang1,3, Chalairat Suk-Ouichai1,4, Yunlin Ye1,5, Lin Lin1, Jianbo Li6,7, Robert Abouassaly1, Steven C Campbell1. 1. Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio. 2. Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Urology, First Hospital of Jilin University, Changchun, China. 4. Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5. Department of Urology Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 6. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 7. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Abstract
PURPOSE: Loss of renal function remains a major limitation of radical nephrectomy. The extent of renal functional compensation by the preserved kidney after radical nephrectomy has not been adequately studied in this elderly population with comorbidities. MATERIALS AND METHODS: A total of 273 patients treated with radical nephrectomy without end stage renal disease with available preoperative nuclear renal scans were included in the analysis. Renal functional compensation was defined as percent change in estimated glomerular filtration rate of the preserved kidney after radical nephrectomy. Estimated glomerular filtration rate was calculated by the Chronic Kidney Disease-Epidemiology Collaboration formula up to 5 years postoperatively. Preoperative/postoperative parenchymal volumes of the preserved kidney were measured from cross-sectional imaging. Multiple regression was used to identify predictive factors for renal functional compensation. RESULTS: Median age was 67 years and 67% of the patients were male. Overall 70% had hypertension, 26% diabetes and 37% preexisting chronic kidney disease. Locally advanced (T3a or greater) tumors were found in 53% of cases. Renal functional compensation was observed at 2 weeks (median 10%) and increased during the first 3 months (median 26%) after radical nephrectomy. Functional stability was then observed to 5 years. Renal parenchymal volume increased a median of 10% at 3 to 12 months but in addition, the functional efficiency per unit of parenchymal volume also increased 8% (estimated glomerular filtration rate units/cm3 of parenchyma was 0.236 postoperatively vs 0.208 preoperatively, p=0.004). Age (-0.85, p <0.01), global preoperative estimated glomerular filtration rate (-0.28, p <0.01) and split renal function of the removed kidney (0.61, p <0.01) were independent predictors of renal functional compensation. CONCLUSIONS: Percent renal functional compensation after radical nephrectomy is greater in younger patients, when preoperative estimated glomerular filtration rate is lower and when the removed kidney has more robust function. Increases in measurable parenchymal mass and functional efficiency contribute substantially to renal functional compensation.
PURPOSE:Loss of renal function remains a major limitation of radical nephrectomy. The extent of renal functional compensation by the preserved kidney after radical nephrectomy has not been adequately studied in this elderly population with comorbidities. MATERIALS AND METHODS: A total of 273 patients treated with radical nephrectomy without end stage renal disease with available preoperative nuclear renal scans were included in the analysis. Renal functional compensation was defined as percent change in estimated glomerular filtration rate of the preserved kidney after radical nephrectomy. Estimated glomerular filtration rate was calculated by the Chronic Kidney Disease-Epidemiology Collaboration formula up to 5 years postoperatively. Preoperative/postoperative parenchymal volumes of the preserved kidney were measured from cross-sectional imaging. Multiple regression was used to identify predictive factors for renal functional compensation. RESULTS: Median age was 67 years and 67% of the patients were male. Overall 70% had hypertension, 26% diabetes and 37% preexisting chronic kidney disease. Locally advanced (T3a or greater) tumors were found in 53% of cases. Renal functional compensation was observed at 2 weeks (median 10%) and increased during the first 3 months (median 26%) after radical nephrectomy. Functional stability was then observed to 5 years. Renal parenchymal volume increased a median of 10% at 3 to 12 months but in addition, the functional efficiency per unit of parenchymal volume also increased 8% (estimated glomerular filtration rate units/cm3 of parenchyma was 0.236 postoperatively vs 0.208 preoperatively, p=0.004). Age (-0.85, p <0.01), global preoperative estimated glomerular filtration rate (-0.28, p <0.01) and split renal function of the removed kidney (0.61, p <0.01) were independent predictors of renal functional compensation. CONCLUSIONS: Percent renal functional compensation after radical nephrectomy is greater in younger patients, when preoperative estimated glomerular filtration rate is lower and when the removed kidney has more robust function. Increases in measurable parenchymal mass and functional efficiency contribute substantially to renal functional compensation.
Entities:
Keywords:
kidney function tests; kidney neoplasms; nephrectomy; outcomes
Authors: Nityam Rathi; Yosuke Yasuda; Worapat Attawettayanon; Diego A Palacios; Yunlin Ye; Jianbo Li; Christopher Weight; Mohammed Eltemamy; Tarik Benidir; Robert Abouassaly; Steven C Campbell Journal: Int Urol Nephrol Date: 2022-07-17 Impact factor: 2.266
Authors: Nityam Rathi; Yosuke Yasuda; Diego Aguilar Palacios; Worapat Attawettayanon; Jianbo Li; Bimal Bhindi; R Houston Thompson; Michael A Liss; Ithaar H Derweesh; Christopher J Weight; Mohammed Eltemamy; Robert Abouassaly; Steven C Campbell Journal: Eur Urol Open Sci Date: 2022-05-05