Effects of metabolic syndrome on renal function after radical nephrectomy in patients with renal cell carcinoma

Abstract

Background: Nephrectomy, partial or radical, remains the standard treatment for renal cell carcinoma (RCC). However, increased risk of chronic kidney disease (CKD) must still be considered. This study aimed to evaluate the effects of concomitant metabolic syndrome (MetS) on renal function in patients with RCC after radical nephrectomy. Methods: Medical records of 310 patients who underwent radical nephrectomy for clear-cell RCC at 900 th Hospital of the Joint Logistics Support Force, PLA from December 2012 to January 2017 were reviewed retrospectively. Estimated glomerular ltration rate (eGFR) and CKD stages were calculated at one week preoperative as baseline and then at postoperative 1 week, 3 months, 12 months and 24 months. MetS patients were identi ed and enrolled in the MetS group (n=31), and a non-MetS group was selected by propensity score matching (n=31). Non-neoplastic renal parenchyma specimens taken at least 2 cm from edge of tumor were evaluated. Results: Baseline characteristics between the two groups were comparable. At 24 months postoperative, mean eGFR levels of the MetS group were signi cantly lower than those in the non-MetS group (62.7 vs. 73.3 ml/min/1.73m 2 ; p=0.004). CKD stages were still more severe in the MetS group than those in the non-MetS group (p = 0.006). The proportions of global sclerosis, tubular atrophy and interstitial brosis were all signi cantly more prevalent in MetS patients, compared to non-MetS patients (all p<0.05). Conclusion: In RCC patients with MetS, the possibility of declining eGFR and CKD progression must be considered after radical nephrectomy. Routine monitoring of renal function must be emphasized.

Research Progress of Metabolic Syndrome and Renal Cancer

“…Alexander et al [14] found that compared with renal cancer patients without underlying disease, MS patients were more likely to have tubular atrophy, renal interstitial fibrosis, and arteriosclerosis, and that glomerular filtration rate (eGFR) was significantly lower in MS patients 1 year after nephrectomy. The study of Zhang et al [15] showed that the eGFR level of MS patients was significantly lower than that of non-MS patients 2 years after radical surgery, and the CKD stage was more severe, and the recovery rate was significantly reduced. Studies have shown that MS can affect the compensation of healthy renal function after unilateral radical nephrectomy in patients with renal cancer.…”

“…The standard-of-care treatment for kidney cancer is partial or radical nephrectomy. However, due to the loss of functional renal parenchyma, the risk of chronic kidney disease (CKD) in patients with MS after radical surgery is significantly increased [14,15]. There is still no consensus on how to identify and assess patients at high risk of CKD before surgery.…”