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Natural history of chronic renal insufficiency after partial and radical nephrectomy

      Abstract

      Objectives. To compare the incidence of newly developed chronic renal insufficiency after partial nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended to preserve renal function; however, studies of transplant donors suggest normal renal function is also maintained after unilateral nephrectomy.
      Methods. We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm or less in the presence of a normal contralateral kidney from 1989 to 2000. Creatinine failure was defined as a serum creatinine value greater than 2.0 mg/dL. Risk factors for renal insufficiency, including diabetes, hypertension, American Society of Anesthesiologists score, age, preoperative creatinine, and history of smoking tobacco, were compared between the two groups. We compared the two groups using the chi-square and Mann-Whitney U tests and the creatinine failure rates using the Kaplan-Meier method.
      Results. One hundred seventy-three patients met the criteria for analysis after RN and 117 did so after PN (median follow-up 25 months). The 5-year freedom from recurrence rate was 96.4% and 98.6% for PN and RN, respectively (P >0.05). The mean preoperative serum creatinine was 1.0 mg/dL (range 0.4 to 1.4) and 0.98 (range 0.6 to 1.5) for RN and PN, respectively (P = 0.4, not significant). The incidence of risk factors for renal insufficiency did not differ between the two groups. The mean postoperative serum creatinine in the RN and PN groups was 1.5 mg/dL (range 0.8 to 3.8) and 1.0 mg/dL (range 0.5 to 1.9), respectively (P <0.001). The chance of creatinine failure over time was significantly greater in the RN group (P = 0.008).
      Conclusions. When controlled for preoperative risk factors for renal insufficiency, patients undergoing RN are at a greater risk of chronic renal insufficiency than a similar cohort of patients undergoing PN.
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      References

        • Konnak J.W.
        • Grossman H.B.
        Renal cell carcinoma as an incidental finding.
        J Urol. 1990; 134: 1094-1096
        • Chow W.H.
        • Devesa S.S.
        • Warren J.L.
        • et al.
        Rising incidence of renal cell cancer in the United States.
        JAMA. 1999; 281: 1628-1631
        • Russo P.
        Renal cell carcinoma.
        Semin Oncol. 2000; 27: 160-176
        • Robson C.J.
        Radical nephrectomy for renal cell carcinoma.
        J Urol. 1963; 89: 37-42
        • Lee C.T.
        • Katz J.
        • Shi W.
        • et al.
        Surgical management of renal tumors 4 cm or less in a contemporary cohort.
        J Urol. 2000; 163: 730-736
        • Belldegrun A.
        • Tsui K.H.
        • deKernion J.B.
        • et al.
        Efficacy of nephron-sparing surgery for renal cell carcinoma.
        J Clin Oncol. 1999; 17: 2868-2875
        • Novick A.C.
        Renal-sparing surgery for renal cell carcinoma.
        Urol Clin North Am. 1993; 20: 277-282
        • Fergany A.F.
        • Hafez K.S.
        • Novick A.C.
        Long-term results of nephron sparing surgery for localized renal cell carcinoma.
        J Urol. 2000; 163: 442-445
        • Najarian J.S.
        • Chavers B.M.
        • McHugh L.E.
        • et al.
        20 years or more of follow-up of living kidney donors.
        Lancet. 1992; 340: 807-810
        • Riehle Jr, R.A.
        • Steckler R.
        • Naslund E.B.
        • et al.
        Selection criteria for the evaluation of living related renal donors.
        J Urol. 1990; 144: 845-848
        • Motzer R.J.
        • Bander N.H.
        • Nanus D.M.
        Renal-cell carcinoma.
        N Engl J Med. 1996; 335: 865-875
        • Orth S.R.
        Smoking—a renal risk factor.
        Nephron. 2000; 86: 12-26
        • He J.
        • Whelton P.K.
        Elevated systolic blood pressure and risk of cardiovascular and renal disease.
        Am Heart J. 1999; 138: 211-219
        • Wolters U.
        • Wolf T.
        • Stutzer H.
        • et al.
        ASA classification and perioperative variables as predictors of postoperative outcome.
        Br J Anaesth. 1996; 77: 217-222
        • Kovacs G.
        • Akhtar M.
        • Beckwith B.J.
        • et al.
        The Heidelberg classification of renal cell tumours.
        J Pathol. 1997; 183: 131-133
        • Hostetter T.H.
        • Olson J.L.
        • Rennke H.G.
        • et al.
        Hyperfiltration in remnant nephrons.
        Am J Physiol. 1981; 241: F85-F93
        • Wishnow K.I.
        • Johnson D.E.
        • Preston D.
        • et al.
        Long-term serum creatinine values after radical nephrectomy.
        Urology. 1990; 35: 114-116
        • Butler B.P.
        • Novick A.C.
        • Miller D.P.
        • et al.
        Management of small unilateral renal cell carcinomas.
        Urology. 1995; 45: 34-41
        • Lau W.K.
        • Blute M.L.
        • Weaver A.L.
        • et al.
        Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney.
        Mayo Clin Proc. 2000; 75: 1236-1242
        • Kaplan E.L.
        • Meier P.
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-467
        • Hsu C.Y.
        • Chertow G.M.
        Chronic renal confusion.
        Am J Kidney Dis. 2000; 36: 415-418
        • Culleton B.F.
        • Larson M.G.
        • Evans J.C.
        • et al.
        Prevalence and correlates of elevated serum creatinine levels.
        Arch Intern Med. 1999; 159: 1785-1790
        • Iseki K.
        • Ikemiya Y.
        • Fukiyama K.
        Risk factors of end-stage renal disease and serum creatinine in a community-based mass screening.
        Kidney Int. 1997; 51: 850-854
        • Anderson R.N.
        United States life tables, 1997.
        Natl Vital Stat Rep. 1999; 47: 1-37

      Linked Article

      • Historical Perspective on Partial Nephrectomy and Renal Functional Preservation
        UrologyVol. 145
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          In this 2002 study from Memorial Sloan Kettering Cancer Center we evaluated the renal functional impact of partial nephrectomy (PN) or radical nephrectomy (RN) for renal tumors of 4 cm or less. We reported that RN patients were more likely to develop renal insufficiency as defined by a serum creatinine of > 2.0 mg/dL.1 This result confirmed similar findings reported from Mayo Clinic2 and both studies brought new concerns for the preservation of renal function into sharp focus for urologists performing kidney tumor operations.
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