Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 1594–1600 | Cite as

Renal Function is Associated with Nephrometry Score After Partial Nephrectomy: A Study Using Diethylene Triamine Penta-Acetic Acid (DTPA) Renal Scanning

  • Taekmin Kwon
  • In Gab Jeong
  • Jeman Ryu
  • Chunwoo Lee
  • Chanwoo Lee
  • Dalsan You
  • Choung-Soo KimEmail author
Urologic Oncology



The aim of this study was to evaluate the effect of renal tumor anatomical characteristics on renal function change after partial nephrectomy using the scoring systems and the glomerular filtration rate (GFR) estimated from diethylene triamine penta-acetic acid (DTPA) scans.


Patients who underwent DTPA renal scans before and after partial nephrectomy from January 2009 to December 2011 were identified retrospectively. The anatomical characteristics of renal tumors were standardized using the RENAL, PADUA and C-index scoring systems. Associations between scoring systems and change in GFRs were evaluated using a correlation coefficient. Predictors of GFR change and postoperative new-onset chronic kidney disease (CKD) after partial nephrectomy were assessed.


A total of 185 patients with a mean tumor size of 2.6 cm (median 2.3, range 0.5–10) were identified. Mean ischemia time was 21.5 min. The last DTPA renal scan was performed at a mean follow-up duration of 23.3 months after surgery, and the mean decrease in GFR was 8.1 ml/min. By multivariable analysis, preoperative GFR (β = −039; p < 0.001), RENAL complexity score (β = −5.32; p < 0.001), and C-index complexity (β = −5.19; p < 0.001) were independent predictors of decreased GFR on DTPA. Of 175 patients in whom preoperative estimated GFR (eGFR) was > 60 ml/min/1.73 m2, CKD developed in 14 (8 %) patients after surgery. Independent factors predicting new-onset CKD were preoperative eGFR (odds ratio [OR] 0.91; p = 0.047), age (OR 1.13; p = 0.003), and diabetes (OR 5.10; p = 0.038).


Although each scoring system describing the complexity of renal tumors correlates with change in GFR after partial nephrectomy, RENAL and C-index score were significantly predictive of GFR reduction.


Chronic Kidney Disease Glomerular Filtration Rate Renal Tumor Partial Nephrectomy Renal Mass 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

Taekmin Kwon, In Gab Jeong, Jeman Ryu, Chunwoo Lee, Chanwoo Lee, Dalsan You, and Choung-Soo Kim have no conflicts of interest or financial disclosures to declare.


  1. 1.
    Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004;100:738-45.PubMedCrossRefGoogle Scholar
  2. 2.
    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281:1628-31.PubMedCrossRefGoogle Scholar
  3. 3.
    Wolf JS Jr, Seifman BD, Montie JE. Nephron sparing surgery for suspected malignancy: open surgery compared to laparoscopy with selective use of hand assistance. J Urol. 2000;163:1659-64.PubMedCrossRefGoogle Scholar
  4. 4.
    Ljungberg B. Nephron-sparing surgery: strategies for partial nephrectomy in renal cell carcinoma. Scand J Surg. 2004;93:126-31.PubMedGoogle Scholar
  5. 5.
    Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163:442-5.PubMedCrossRefGoogle Scholar
  6. 6.
    Russo P, Huang W. The medical and oncological rationale for partial nephrectomy for the treatment of T1 renal cortical tumors. Urol Clin North Am. 2008;35:635–43; vii.Google Scholar
  7. 7.
    Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56:786-93.PubMedCrossRefGoogle Scholar
  8. 8.
    Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53.PubMedCrossRefGoogle Scholar
  9. 9.
    Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol. 2010;183:1708-13.PubMedCrossRefGoogle Scholar
  10. 10.
    Bruner B, Breau RH, Lohse CM, Leibovich BC, Blute ML. Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int. 2011;108:67-72.PubMedCrossRefGoogle Scholar
  11. 11.
    Okhunov Z, Rais-Bahrami S, George AK, et al. The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores. J Endourol. 2011;25:1921-4.PubMedCrossRefGoogle Scholar
  12. 12.
    Samplaski MK, Hernandez A, Gill IS, Simmons MN. C-index is associated with functional outcomes after laparoscopic partial nephrectomy. J Urol. 2010;184:2259-63.PubMedCrossRefGoogle Scholar
  13. 13.
    Gaspari F, Perico N, Remuzzi G. Application of newer clearance techniques for the determination of glomerular filtration rate. Curr Opin Nephrol Hypertens. 1998;7:675-80.PubMedCrossRefGoogle Scholar
  14. 14.
    Bylund JR, Gayheart D, Fleming T, et al. Association of tumor size, location, R.E.N.A.L., PADUA and centrality index score with perioperative outcomes and postoperative renal function. J Urol. 2012;188:1684-9.PubMedCrossRefGoogle Scholar
  15. 15.
    Gates GF. Glomerular filtration rate: estimation from fractional renal accumulation of 99 mTc-DTPA (stannous). AJR Am J Roentgenol. 1982;138:565-70.PubMedCrossRefGoogle Scholar
  16. 16.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.Google Scholar
  17. 17.
    Patard JJ, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52:148-54.PubMedCrossRefGoogle Scholar
  18. 18.
    Crispen PL, Boorjian SA, Lohse CM, et al. Outcomes following partial nephrectomy by tumor size. J Urol. 2008;180:1912-7.PubMedCrossRefGoogle Scholar
  19. 19.
    Song C, Park S, Jeong IG, et al. Followup of unilateral renal function after laparoscopic partial nephrectomy. J Urol. 2011;186:53-8.PubMedCrossRefGoogle Scholar
  20. 20.
    Simmons MN, Hillyer SP, Lee BH, Fergany AF, Kaouk J, Campbell SC. Nephrometry score is associated with volume loss and functional recovery after partial nephrectomy. J Urol. 2012;188:39-44.PubMedCrossRefGoogle Scholar
  21. 21.
    Cha EK, Ng CK, Jeun B, et al. Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy. World J Urol. 2013;31:817-22.PubMedCrossRefGoogle Scholar
  22. 22.
    Mehrazin R, Palazzi KL, Kopp RP, et al. Impact of tumour morphology on renal function decline after partial nephrectomy. BJU Int. 2013;111:E374-82.PubMedCrossRefGoogle Scholar
  23. 23.
    Choi JD, Park JW, Choi JY, et al. Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate. Eur Urol. 2010;58:900-5.PubMedCrossRefGoogle Scholar
  24. 24.
    Desai MM, Gill IS, Ramani AP, Spaliviero M, Rybicki L, Kaouk JH. The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy. BJU Int. 2005;95:377-83.PubMedCrossRefGoogle Scholar
  25. 25.
    Thompson RH, Leibovich BC, Lohse CM, Zincke H, Blute ML. Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol. 2005;174:855-8.PubMedCrossRefGoogle Scholar
  26. 26.
    Ward JP. Determination of the Optimum temperature for regional renal hypothermia during temporary renal ischaemia. Br J Urol. 1975;47:17-24.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Taekmin Kwon
    • 1
    • 2
  • In Gab Jeong
    • 2
  • Jeman Ryu
    • 2
  • Chunwoo Lee
    • 2
  • Chanwoo Lee
    • 2
  • Dalsan You
    • 2
  • Choung-Soo Kim
    • 2
    Email author
  1. 1.Department of Urology, Ulsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
  2. 2.Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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