Risk of chronic kidney disease after cancer nephrectomy

Li, Lin; Lau, Wei Ling; Rhee, Connie M.; Harley, Kevin; Kövesdy, Csaba P.; Sim, John J.; Jacobsen, Søren; Chang, Anthony; Landman, Jaime; Kalantar-Zadeh, Kamyar

doi:10.1038/nrneph.2013.273

Cited by 63 publications

(60 citation statements)

References 108 publications

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“…In a recent review, Li et al (15) found worse postoperative renal outcomes among patients undergoing RN than those having PN. These studies have resulted in the recommendation to perform PN whenever technically feasible to best preserve renal function for patients undergoing a nephrectomy for renal cell carcinoma (15).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

Zabor

Furberg

Mashni

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Partial nephrectomy or radical nephrectomy is the standard of care for patients with kidney neoplasms, but surgery may result in loss of renal function. We sought to identify patient characteristics associated with renal functional recovery following radical nephrectomy.Design, setting, participants, & measurements We performed a retrospective study among 572 patients with kidney neoplasms who underwent RN between 2006 and 2013. The primary endpoint was recovery of postoperative eGFR to the preoperative level. We plotted the trajectory of each patient's eGFR from their first postoperative visit up to 3 years after surgery. Cumulative incidence and competing risks regression estimated associations between patient and clinical characteristics and eGFR recovery, stratified by preoperative eGFR.Results Median age was 61.5 years; 68% of patients were male, and 89% were white. Overall, eGFR increased over time following an initial postoperative decrease. Median postoperative follow-up among survivors was 10.8 (minimum, 0.03; maximum, 36.0) months; during follow-up, 263 patients achieved eGFR recovery. Median time to eGFR recovery was 25.3 months. Two-year cumulative incidence of eGFR recovery was 49% overall and 44% and 58% among those with preoperative eGFR$60 and ,60 ml/min per 1.73 m 2 , respectively (P,0.001). On multivariable analysis, younger age at surgery and female sex were significantly associated with a higher chance of eGFR recovery among patients with preoperative eGFR,60 ml/min per 1.73 m 2 . Among patients with preoperative eGFR$60 ml/min per 1.73 m 2 , hypertension was significantly associated with a lower chance of eGFR recovery, whereas increased tumor size was significantly associated with a higher chance of eGFR recovery.Conclusions Overall, almost half of the patients in this study recovered to their preoperative eGFR by 2 years following surgery. Distributions of preoperative risk factors differed by preoperative eGFR, leading to distinct factors that were significantly associated with chance of eGFR recovery.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

Zabor

Furberg

Mashni

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Although associated with slightly higher disease progression than observed for surgical treatment (PN), ablative therapies resulted in fewer procedural complications, shorter duration of hospitalization, and greater GFR preservation. 64,74,75 When excluding those with high risk for recurrence, oncologic outcomes were equivalent with PN. 80 These alternative therapies also enable treatment for those with high operative risk.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 95%

“…63 After surgical resection, the prevalence of CKD rose from 10%-24% to 16%-52%. [58][59][60] Postoperative risk of new diagnosis or progression of CKD was also related to these same risk factors 64,65 but also included obesity, 65,66 decreased GFR, larger tumor size 60,63 and corresponding renal volume reduction, 67 hypoalbuminemia, 59 and postoperative AKI. 68 Diabetes mellitus and preexisting CKD likewise increased risk for progression to ESRD (4.05% for RCC versus 0.68% for control with hazard ratio [HR], 5.63; 95% confidence interval [95% CI], 4.37 to 7.24) over a 10-year follow-up period in an incident cohort (RCC, n=2940; control, n=23,520).…”

Section: Presurgical Ckd Risk and Preventionmentioning

confidence: 99%

“…Nephron-sparing procedures, including partial nephrectomy (PN) and ablative therapies, are emerging as mainstream therapies for SRMs, because accumulating evidence has shown comparable oncologic and overall survival and greater renal preservation. 64,74,75 Moreover, many cohort studies showed a survival advantage and greater GFR preservation with PN. 75 Correspondingly, a meta-analysis evaluated findings across 36 studies (mostly retrospective cohort studies) including 40,000 patients (31,000 RN and 9300 PN) and found that treatment of SRMs with PN conferred a 19% risk reduction for all-cause mortality and a 29% risk reduction for cancer-specific mortality.…”

Section: Clinicopathogic/pathologic Considerationsmentioning

confidence: 99%

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The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

Chang

Perazella

et al. 2016

JASN

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Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is underrecognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel-Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes. Therefore, RCC is labeled the internist's tumor. In light of this characterization and multiple other metabolic abnormalities recently associated with ccRCC, it can now be viewed as a metabolic disease. In this review, we discuss the basic biology, pathology, and approaches for treatment of RCC. It is important to distinguish between kidney confinement and distant spread of RCC, because this difference affects diagnostic and therapeutic approaches and patient survival, and it is important to recognize the key interplay between RCC, RCC therapy, and CKD. Better understanding of all aspects of this disease will lead to optimal patient care and more recognition of an increasingly prevalent nephrologic disease, which we now appropriately label the nephrologist's tumor.

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“…[3][4][5] However, all renal cancers cannot be indications for the partial nephrectomy. The partial nephrectomy for pT1b or larger renal cancer is challenging and has high morbidity.…”

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confidence: 99%

Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy

Kim

Kang

et al. 2018

KMJ

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Radical nephrectomy has been treatment of choice for organ confined renal cancer with contralateral normal kidney, because radical nephrectomy can cure the renal cancer with minimal immediate problems associated with health-related quality of life due to end stage renal disease, hemodialysis, and etc. Recently, however, many small renal masses -incidentalloma -are diagnosed at health screening, and consequent nephron-sparing surgery is increasing and accepted due to benefit of residual renal function. Objectives: The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. Methods: We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. Results: The mean age was 65.5 years (range, 45-77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P = 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P = 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. Conclusions: Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.

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Risk of chronic kidney disease after cancer nephrectomy

Cited by 63 publications

References 108 publications

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy

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