Predicting Development Of Chronic Renal Impairment After Nephrectomy For Malignancy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 21 Jun 2008 - 5:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Lim presented a study attempting to identify factors that predict post-operative deterioration to stage 4 chronic renal disease (GFR <25ml/min) in patients undergoing radical (RN) or partial nephrectomies (PN) from the University of Western Ontario.

A total of 417 patients who underwent RN or PN from January 1997 to December 2003 were considered for this study. Included were 206 patients who had normal contralateral kidney, absence of chronic renal impairment (pre-operative GFR 70 ml/min) and at least 1 year of follow-up post surgery. GFR pre- and post- surgery was calculated using the Modification of Diet in Renal Disease equation. After a median follow-up of 50 months post RN, pre-operative GFR < 80 was found to be associated with deterioration towards stage 4 chronic renal disease (p<0.01). Importantly, all RN pts with a pre-operative GFR >80 remained off dialysis, whereas 7.9% with pre-operative GFR <80 required chronic dialysis. At 3 and 5 years of follow-up, the decline in GFR was significant higher in the RN (n=161) vs PN (n=45) group (34.1 vs 9.3 ml/min, p<0.0001) and (35.8 vs 13.7, p<0.005), respectively. In patients undergoing RN, pre-operative GFR <80 ml/min predicts progression to stage 4 renal failure. PN reduces long-term decline in GFR compared with RN and should be offered to suitable patients; especially those with a pre-op GFR <80.

This study adds support to the existing data that indicates the importance of a nephron-sparing approach in those patients with tumors amenable to PN, especially in those patients with pre-existing decreased renal function. Ongoing work attempts to identify medications or other factors that can be modified in order to attempt to save more nephrons, particularly in those at higher risk.

Moderated by: : Marston Linehan, MD, and Jamie Landman, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Geoff Box, MD

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