To externally validate the Spectrum Score (SS) using a modified calculation based on functional parenchymal volumes (FPVs) instead of renal scans. The SS quantifies acute ischemic injury in the ipsilateral kidney after partial nephrectomy. However, this metric requires renal split function assessment via renal scans, which may be unavailable in routine practice.
We retrospectively reviewed patients with a solitary renal mass and contralateral kidney who underwent partial nephrectomy at our institution between 2015 and 2017. FPVs were calculated using cylindrical volume approximation and used to quantitate relative renal function. Based on renal split function and parenchyma preserved, we determined creatinineideal, assuming no ipsilateral kidney ischemic injury, and creatinineworst-case, assuming temporary ipsilateral kidney nonfunction. FPV-based SS was defined as follows: (observed peak creatinine−creatinineideal)/(creatinineworst-case−creatinineideal). Functional recovery was defined as follows: (% function saved)/(% parenchyma preserved). Factors associated with FPV-based SS and functional recovery were assessed using linear regression.
We assessed 174 patients with a median renal mass size of 2.7 cm (IQR 2.0-3.6), warm ischemia time of 26.0 minutes (IQR 19.0-34.3), and parenchyma preservation of 92.6% (IQR 80.8-100). Preoperative ipsilateral kidney % split function (P = .003), preoperative ipsilateral kidney glomerular filtration rate (P = .045), and warm ischemia time (P = .005) were independently associated with FPV-based SS. Only FPV-based SS (P<.001) was independently associated with functional recovery.
The FPV-based SS, which does not require renal scans, quantifies acute ipsilateral renal dysfunction and predicts functional recovery after partial nephrectomy.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Urology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- EAU guidelines on renal cell carcinoma: 2014 update.Eur Urol. 2015; 67: 913
- Guideline for management of the clinical T1 renal mass.J Urol. 2009; 182: 1271
- Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival.J Urol. 2014; 192: 1057
- Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate.Eur Urol. 2015; 68: 996
- Acute kidney injury and chronic kidney disease as interconnected syndromes.N Engl J Med. 2014; 371: 58
- Predictors of long-term survival after renal cancer surgery.J Urol. 2018; 199: 384
- Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease.J Urol. 2013; 189: 1649
- Acute kidney injury after partial nephrectomy: role of parenchymal mass reduction and ischemia and impact on subsequent functional recovery.Eur Urol. 2016; 69: 745
- Poorly functioning kidneys recover from ischemia after partial nephrectomy as well as strongly functioning kidneys.J Urol. 2014; 192: 665
- Residual parenchymal volume, not warm ischemia time, predicts ultimate renal functional outcomes in patients undergoing partial nephrectomy.Urology. 2015; 86: 300
- Acute ipsilateral renal dysfunction after partial nephrectomy in patients with a contralateral kidney: spectrum score to unmask ischemic injury.Eur Urol. 2016; 70: 692
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group.Ann Intern Med. 1999; 130: 461
- Effect of parenchymal volume preservation on kidney function after partial nephrectomy.J Urol. 2011; 186: 405
- The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.J Urol. 2009; 182: 844
- Evaluation of renal growth by magnetic resonance imaging and computerized tomography volumes.J Urol. 2003; 170: 1659
- Three-dimensional renal parenchymal volume as a surrogate for renal function estimation in obstructed kidneys undergoing surgical repair.J Endourol. 2015; 29: 630
- Evaluation of sonographic renal parenchymal area in the management of hydronephrosis.J Urol. 2001; 165: 548
- Differential renal function estimation using computerized tomography based renal parenchymal volume measurement.J Urol. 2010; 183: 2289
- The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy.Clin Exp Nephrol. 2017;
- Comparison of renal scintigraphy and computed tomographic renal volumetry for determining split renal function and estimating post-transplant renal function.Transplant Proc. 2015; 47: 2700
- Correlation between CT-based measured renal volumes and nuclear-renography-based split renal function in living kidney donors. Clinical diagnostic utility and practice patterns.Clin Transplant. 2014; 28: 675
- Surgeon assessment of renal preservation with partial nephrectomy provides information comparable to measurement of volume preservation with 3-dimensional image analysis.J Urol. 2014; 191: 1218
- Multicenter validation of surgeon assessment of renal preservation in comparison to measurement with 3d image analysis.Urology. 2015; 86: 534
- Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney.Urology. 2012; 79: 356
- Ischemia and functional recovery from partial nephrectomy: refined perspectives.Eur Urol Focus. 2017;
Published online: July 28, 2018
Accepted: July 17, 2018
Received in revised form: July 15, 2018
Received: May 31, 2018
Funding Support: Gitlin Family Foundation and the Roberta R. & Ernest Scheller Jr. Family Foundation, and NIH HHS, United States (grant P30 CA006927/CA/NCI).
Financial Disclosure: All authors have no conflicts of interest or financial ties to disclose.
© 2018 Elsevier Inc. All rights reserved.