Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance

Abstract

Background: Radiographic characteristics may be associated with the degree of renal function preservation following partial nephrectomy. The purpose of this study was to determine the impact of preoperative radiographic variables on change in renal function using 24-hour urine creatinine clearance (uCrCl). Methods: Patients with partial nephrectomy performed from November 2003 to 2008 were enrolled in the study. Serum creatinine and 24-hour urine was collected preoperatively and at 3, 6 and 12 months postoperatively. Computed tomography or magnetic resonance imaging was used to determine tumour size, tumour location and renal volume. Results: Of the 36 patients, median age was 62 (range 30-78) and 21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm. Twenty-two (61%) tumours were located at the renal pole and 11 (31%) were endophytic. Overall, mean preoperative uCrCl was 88.8±34.2 mL/min and mean postoperative uCrCl was 82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis, no single characteristic was associated with a clinically prohibitive decrease in renal function (-9.4% if endophitic, p = 0.06; -0.57% per cm diameter, p = 0.73; and -6.9% if located at the renal pole, p = 0.15). The total renal volume was also not significantly associated with renal function change (-1.1% per 100 cc, p = 0.86). Interpretation: Preoperative radiographic characteristics seem to be associated with small changes in renal function following partial nephrectomy. These data support renal functional benefits of partial nephrectomy regardless of tumour size and location. RésuméContexte : Les caractéristiques radiographiques peuvent être associées au niveau de préservation de la fonction rénale après une néphrectomie partielle. L'objectif de l'étude était d'évaluer l'impact de variables radiographiques préopératoires sur les variations de la fonction rénale à l'aide de la mesure de la clairance de la créatinine dans les urines recueillies sur 24 heures (ClCrU). Selon l'analyse multivariée, aucune caractéristique particulière n'était associée à une réduc-tion cliniquement excessive de la fonction rénale (-9,4 % pour les tumeurs endophytiques, p = 0,06; -0,57 % par cm de diamètre, p = 0,73, et -6,9 % si la tumeur était située à un pôle rénal, p = 0.15). Le volume rénal total n'était pas non plus associé de façon significative à une variation de la fonction rénale (-1,1 % pour 100 mL, p = 0.86). Interprétation : Les caractéristiques radiographiques préopératoires semblent associées à de petites variations de la fonction rénale après une néphrectomie partielle. Ces données appuient les avantages liés à la fonction rénale de la néphrectomie partielle, peu importe la taille et le siège de la tumeur.

Ameliorative Efficacy of Egyptian Pyramid Model Housing on Unilateral Nephrectomized Rats

“…Direct measurements of GFR are uncommonly performed on partial nephrectomy patients. Therefore, most partial nephrectomy renal function studies rely on estimates of glomerular filtration based on serum creatinine [38]. In conjunction with the report of Zorn et al [39], Chapman et al [40]; Nutter et al [41] and Saito et al [42], UNx is associated with an acute and significant drop in the GFR which may be due to the immediate loss of renal mass.…”