Declinining Baseline GFR Impacts Survival in Patients Undergoing Partial or Radical Nephrectomy for Renal Cortical Tumors

Pettus, Joseph A.; Jang, Thomas L.; Thompson, R. Houston; Yossepowitch, Ofer; Kagiwada, Megan A.; Russo, Paul

doi:10.1016/s0022-5347(08)61106-4

Cited by 3 publications

(7 citation statements)

References 22 publications

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“…The higher level of impairment in renal function associated with RN may increase cardiovascular mortality in the long term as well as mortality unrelated to cardiovascular events [12,13,26]. As has been stated, RN and NSS offer similar oncological outcomes [2,3], and for this reason when choosing the best way to manage stage T1 renal cell tumours it is important to evaluate the possible deleterious effect of the therapeutic measures to be used, since generally speaking these tumours have a good prognosis, with mortality rates of less than 15% after 5 years [27].…”

Section: Overall Survival Distribution Functionmentioning

confidence: 89%

“…Cancer-specific survival rates (radical nephrectomy vs nephron-sparing surgery). glomerular filtration figures below this last cut-off point is important, since values below 40-45 ml/ min/1.73m 2 have been associated in some studies with higher mortality rates in the general population [2,3].…”

Section: Partial Radicalmentioning

confidence: 97%

“…In Western countries up to 40-70% of renal tumours are diagnosed incidentally [2][3][4]. Some series in the relevant literature show that conservative renal surgery provides optimal oncological control in renal tumours of less than 4 cm in diameter [2,5], and these same oncological outcomes with the use of both techniques are currently being demonstrated in neoplasms of up to 7 cm [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…These diagnostic and therapeutic considerations should also include functional aspects and, as far as this aspect is concerned, a variety of studies shows that, in comparison with nephron-sparing surgery (NSS), RN entails a greater risk of impairment of renal function, which may evolve into chronic renal failure [2,3,8]. This condition is related to a greater risk of complications, comorbidity and even mortality [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Polo¹,

Romero-Otero²,

Rodrı́guez-Antolı́n³

et al. 2011

Scandinavian Journal of Urology and Nephrology

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Section: Overall Survival Distribution Functionmentioning

confidence: 89%

Section: Partial Radicalmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Polo¹,

Romero-Otero²,

Rodrı́guez-Antolı́n³

et al. 2011

Scandinavian Journal of Urology and Nephrology

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“…The relationship between RCC and metabolic syndrome is an important area of future research as the worldwide incidence of obesity is ever increasing. [15,[20][21][22]. Pettus et al [21] assessed 1479 patients who underwent PN or RN over a 10-year period and found that patients with a baseline eGFR of <45 and <30 mL/min/1.73 m 2 had a significantly reduced OS (HR 1.5, P < 0.003; and HR 2.8, P < 0.001, respectively).…”

Section: Discussionmentioning

confidence: 99%

Elevated preoperative C‐reactive protein is associated with renal functional decline and non‐cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC)

Cotta¹,

Meagher²,

Patil

et al. 2020

BJU International

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Objective To investigate association of preoperative C‐reactive protein (CRP) and non‐cancer mortality (NCM) in a cohort of patients undergoing surgery for localised renal cell carcinoma (RCC). Patients and Methods Retrospective multicentre analysis of patients surgically treated for clinical Stage 1–2 RCC from 2006 to 2017, excluding all cases of cancer‐specific mortality. Descriptive analyses were obtained between the pre‐treatment normal‐CRP (≤5 mg/L) and elevated‐CRP (>5 mg/L) groups. The primary outcome was NCM. The secondary outcomes included progression to de novo chronic kidney disease Stages 3–4 (estimated glomerular filtration rate [eGFR] of <60, <45, and <30 mL/min/1.73 m2). Multivariable analyses (MVA) were performed to assess for risk factors associated with functional decline and NCM, and Kaplan–Meier analysis was used to obtain survival estimates for outcomes. Results A total of 1987 patients who underwent radical or partial nephrectomy were analysed (normal‐CRP group, n = 963; elevated‐CRP group, n = 1024). Groups were similar in age (59 vs 60 years, P = 0.079). An elevated CRP was more frequent in males (36.8% vs 27.8%, P < 0.001), African‐Americans (22.6% vs 2.9%, P < 0.001), and in those with a higher median body mass index (30 vs 25 kg/m2, P < 0.001) and larger median tumour size (4.5 vs 3.3 cm, P < 0.001). On MVA, an elevated CRP was independently associated with development of de novo eGFR of <60 mL/min/1.73 m2 (hazard ratio [HR] 1.32, P = 0.015), <45 mL/min/1.73 m2 (HR 1.41, P = 0.023) and <30 mL/min/1.73 m2 (odds ratio 2.23, P < 0.001). The MVA for factors associated with NCM demonstrated increasing age (HR 1.06, P < 0.001), preoperative elevated CRP (HR 2.18, P < 0.001) and an eGFR of <45 mL/min/1.73 m2 (HR 1.16; P = 0.021) as independent risk factors. Kaplan–Meier analysis revealed significantly higher 5‐year NCM in the elevated‐CRP group vs the normal‐CRP group (98% vs 80%, P < 0.001). Conclusions Pre‐treatment elevated CRP was independently associated with both progressive renal functional decline and NCM in patients undergoing surgery for Stage 1–2 RCC. Patients with elevated CRP and Stage 1 and 2 RCC may be considered as having indication for nephron‐sparing strategies, which may be prioritised if oncologically appropriate.

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Post nephrectomy renal function: Donor nephrectomy vs. radical nephrectomy

et al. 2022

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Background/Aim. Monitoring the renal function following donor or radical nephrectomy due to kidney tumors is considered to be essential. The aim of this study was to compare pre-operative and post-operative renal function in patients who underwent donor nephrectomy in relation to patients who underwent radical nephrectomy due to renal malignancy. Methods. A retrospective case-control study was performed, which included 199 patients divided into two groups: Group 1 (105 patients) were patients who underwent donor nephrectomy due to living related/unrelated kidney transplantation, while group 2 (94 patients) was a control group and included patients who underwent radical nephrectomy due to clear cell renal cell carcinoma in the T1bNoM0 clinical stage, where this surgical procedure was the final form of treatment. Results. Pre-operative eGFR EPI in the donor group was 94.95 ml/min/1.73m2, while in the radical nephrectomy patient group it was 71.00 ml/min/1.73m2. Patients who underwent radical nephrectomy tended to have GFR below 60 ml/min/1.73m2 after ten years of follow-up compared with patients who underwent donor nephrectomy. In the donor nephrectomy group, the average GFR was 80.40 ml/min/1.73m2 and in the radical nephrectomy group it was 56.00 ml/min/1.73m2. A higher incidence of diabetes and hypertension was also observed in the donor nephrectomy group of patients compared to the radical nephrectomy group (HTA: 44.3% vs. 21.3%; diabetes: 22.6% vs. 9.6%, respectively). Conclusion. Comparative monitoring of these two groups showed that in both groups the recovery of renal reserve was achieved one year after nephrectomy, due to the known adaptive mechanisms. Regardless of the fact that with live transplantation in a kidney donor, we reduce the initial renal reserve (nephrectomy, permanent loss of renal mass), due to the adaptive mechanisms, kidney donors recover the kidney function within the first year after surgery.

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Declinining Baseline GFR Impacts Survival in Patients Undergoing Partial or Radical Nephrectomy for Renal Cortical Tumors

Cited by 3 publications

References 22 publications

Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Elevated preoperative C‐reactive protein is associated with renal functional decline and non‐cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC)

Post nephrectomy renal function: Donor nephrectomy vs. radical nephrectomy

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