Comparison of renal function following donor nephrectomy versus radical nephrectomy for renal tumor

Abstract

In this study, we compared renal function in patients after donor nephrectomy (DN) and radical nephrectomy (RN). We retrospectively reviewed 68 patients (mean follow-up 15 months), including 30 patients who had undergone DN and 38 patients who had undergone RN. The study was performed between April 2006 and July 2010 at a single institute. Patients were matched for age and co-morbidities (hypertension and diabetes mellitus). We calculated the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease study group equation. Parameters studied included GFR (≥60 to <60 mL/min/1.73 m 2 ), serum creatinine (>2.0 mg/dL), metabolic acidosis (serum bicarbonate <22 mmol/L) and proteinuria (>30 mg). There were no significant demographic differences between the two study groups. After a mean follow-up of 15 months, low eGFR (<60 mL/min/1.73 m 2 ) was seen in 28% and 6.7% of patients in the RN and DN groups, respectively (P = 0.03). Similarly, proteinuria was seen in 21% vs 0%, P = 0.007, and de novo elevated creatinine was seen in 13% vs 0%, respectively P = 0.04; thus the changes were greater in the RN group. Our study shows that undergoing RN had a significantly greater risk of developing renal insufficiency and proteinuria compared with age-and co-morbidity-matched patients undergoing DN. We concluded that patients undergoing RN show a significantly greater risk of developing renal insufficiency and proteinuria compared with the patients undergoing DN.

Comparison of long-term kidney functions after radical nephrectomy and simple nephrectomy

“…Thus collaboration of urologists, pathologist and nephrologist is vital in management of renal cancer patients (Chang et al, 2014). In concordance with this suggestion, studies comparing the renal function after donor nephrectomy and radical nephrectomy reported better renal functions after donor nephrectomy (Gazel et al, 2015; Etafy et al, 2015). This might be a consequence of strict preoperative evaluation of renal donors.…”

The Effect of Patient and Surgical Characteristics on Renal Function After Partial Nephrectomy

“…Potential reasons for this difference are that given the chronic nature of CKD-M, these patients likely have decreased renal reserve, which in turn increases the diseased nephron’s susceptibility to surgical injury followed by persistent damage after surgery imparted by pre-existing medical conditions such as hypertension and diabetes. Furthermore, several reports comparing renal functional outcomes between patients undergoing donor nephrectomy (DN) and renal surgery for RCC found that the DN group experience significant improvements in eGFR post-operatively compared to the RCC group 9,20 . Compared with DN patients, those with RCC are more likely to present with baseline CKD risk factors such as diabetes, hypertension, and increased age.…”

“…Putative baseline clinical demographic factors that impact post-operative renal function in patients undergoing extirpative renal surgery include pre-operative eGFR, age at surgery, tumor size, and the presence of medical comorbidities such as diabetes and hypertension 7,8 . In a comparison between patients undergoing donor nephrectomy (DN) versus RN for a renal cortical tumor, at a mean follow up of 15 months post-surgery, RN patients were more likely to have low eGFR, proteinuria, and de novo elevated creatinine levels than those who underwent DN 9 . These findings support the notion that non-surgical factors as well as vulnerabilities affecting cancer patients play a role in subsequent renal function.…”

Open radical nephrectomy for early treatment of renal cell carcinoma: a case report and review

“…4,28 Decreased renal functional capacity could lead to renal retention acid load contributing to the presentation of metabolic acidosis. 27 As for other forms of treatment, it has questioned the effectiveness of interventional radiology techniques based on histological findings that suggest the failure of ablation to eliminate malignant cells or to achieve the same tumor-free margins and surgical procedures. 25…”