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Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy

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Abstract

Purpose

We analyzed radiographic parameters describing anatomic features of renal tumors to identify preoperative characteristics that could help predict long-term decline in renal function following partial nephrectomy.

Methods

We retrospectively reviewed the records of 194 consecutive patients who underwent partial nephrectomy from January 2006 to March 2009 and analyzed a cohort of 53 patients for whom complete clinical, radiographic, and operative information was available. Computed tomography images were reviewed by a single radiologist. Radiographic criteria for describing renal tumor size and location included diameter, volume, endophytic properties, proximity to collecting system, anterior/posterior location, location relative to polar lines, and R.E.N.A.L. nephrometry score. Postoperative estimated glomerular filtration rate was calculated using the MDRD study group equation with serum creatinine at last follow-up.

Results

The median preoperative and postoperative GFR values were 75 (IQR 65–97) and 66 (IQR 55–84) mL/min/1.73 m2, respectively. At a median follow-up of 38 months, the median percentage decrease in GFR was 12%. On univariate analyses, tumor diameter (P = 0.002), tumor volume (P < 0.0001), nearness of tumor to collecting system (P = 0.017), and location relative to polar lines (P = 0.017) were associated with percentage decrease in GFR. Furthermore, higher R.E.N.A.L. nephrometry score was also associated with poorer renal functional outcomes following partial nephrectomy (P = 0.019).

Conclusions

Anatomic features of renal tumors defined by preoperative radiographic characteristics correlate with the degree of renal functional decline after partial nephrectomy. Identification of these parameters may assist in patient counseling and clinical decision making following partial nephrectomy. Validation in larger prospective studies is necessary.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

EBL:

Estimated blood loss

eGFR:

Estimated glomerular filtration rate

GFR:

Glomerular filtration rate

IQR:

Interquartile range

MDRD:

Modification of Diet in Renal Disease

PN:

Partial nephrectomy

RCT:

Renal cortical tumor

RN:

Radical nephrectomy

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, Starr 900, 525 East 68th St., Box 94, New York, NY, 10065, USA

    Eugene K. Cha, Casey K. Ng, Jennifer E. Reifsnyder, James R. DiPietro, Joseph J. Del Pizzo, Shahrokh F. Shariat & Douglas S. Scherr

  2. Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Bryan Jeun, George Shih & Yong H. Auh

  3. Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Allison Dunning & Madhu Mazumdar

  4. Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Shahrokh F. Shariat

Authors
  1. Eugene K. Cha
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  2. Casey K. Ng
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  3. Bryan Jeun
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  4. Allison Dunning
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  5. Jennifer E. Reifsnyder
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  6. James R. DiPietro
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  7. Madhu Mazumdar
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  8. George Shih
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  9. Yong H. Auh
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  10. Joseph J. Del Pizzo
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  12. Douglas S. Scherr
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Correspondence to Eugene K. Cha.

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Cha, E.K., Ng, C.K., Jeun, B. et al. Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy. World J Urol 31, 817–822 (2013). https://doi.org/10.1007/s00345-011-0694-z

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  • DOI: https://doi.org/10.1007/s00345-011-0694-z

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