Factors Predicting Renal Functional Outcome After Partial Nephrectomy

No AccessJournal of UrologyAdult Urology1 Dec 2008Factors Predicting Renal Functional Outcome After Partial Nephrectomy Brian R. Lane, Denise C. Babineau, Emilio D. Poggio, Christopher J. Weight, Benjamin T. Larson, Inderbir S. Gill, and Andrew C. Novick Brian R. LaneBrian R. Lane Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Denise C. BabineauDenise C. Babineau Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio , Emilio D. PoggioEmilio D. Poggio Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Christopher J. WeightChristopher J. Weight Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Benjamin T. LarsonBenjamin T. Larson Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Inderbir S. GillInderbir S. Gill Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , and Andrew C. NovickAndrew C. Novick Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio View All Author Informationhttps://doi.org/10.1016/j.juro.2008.08.036AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Compared to radical nephrectomy, partial nephrectomy better preserves renal parenchyma and function. Although several clinical factors may impact renal function after partial nephrectomy including preoperative function, age, gender and comorbidities, the contributions of tumor and surgical factors have not been well studied. We evaluate independent factors predicting functional outcomes after partial nephrectomy. Materials and Methods: Preoperative and all postoperative serum creatinine values for 1,169 patients undergoing partial nephrectomy were used to estimate glomerular filtration rate. Postoperative nadir glomerular filtration rate and ultimate glomerular filtration rate were analyzed using multiple pertinent covariates. Results: Median preoperative, postoperative nadir and ultimate glomerular filtration rates were 77, 57 and 71 ml per minute per 1.73 m2, respectively. Increasing age, gender, lower preoperative glomerular filtration rate, solitary kidney, tumor size, ischemia time and longer time to nadir glomerular filtration rate significantly predicted postoperative nadir glomerular filtration rate and ultimate glomerular filtration rate. Acute loss of renal function predicted lower ultimate glomerular filtration rate. In the entire cohort, in patients with normal preoperative renal function, and in those with baseline stage 3 and those with stage 4 chronic kidney disease the incidence of postoperative acute kidney injury after partial nephrectomy was 3.6%, 0.8%, 6.2% and 34%, and the incidence of chronic end stage renal disease after partial nephrectomy was 2.5%, 0.1%, 3.7% and 36%, respectively. Conclusions: Lower preoperative glomerular filtration rate, solitary kidney, older age, gender, tumor size and longer ischemic interval all predicted lower glomerular filtration rate after partial nephrectomy. Therefore, duration of renal ischemia is the strongest modifiable surgical risk factor for decreased renal function after partial nephrectomy, and efforts to limit ischemic time and injury should be pursued in open and laparoscopic partial nephrectomy. References 1 : Symptoms as well as tumor size provide prognostic information on patients with localized renal tumors. J Urol2004; 172: 2167. 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Volume 180Issue 6December 2008Page: 2363-2369 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsischemiaglomerular filtration ratekidney function testsrenal cellcarcinomanephrectomyMetricsAuthor Information Brian R. Lane Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Denise C. Babineau Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Emilio D. Poggio Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Christopher J. Weight Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Benjamin T. Larson Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Inderbir S. Gill Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Financial interest and/or other relationship with Hansen Medical. More articles by this author Andrew C. Novick Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Expand All Advertisement PDF downloadLoading ...