Onconephrology pp 209-217 | Cite as

Renal Cell Carcinoma and Chronic Kidney Disease



Over the past two decades, there has been a notable increase in the early diagnosis of kidney cancers. Earlier diagnosis is likely due to a myriad of findings including more aggressive imaging of patients with microscopic hematuria. While, approximately 20–25 % of these small renal masses are benign (oncocytoma or angiomyolipoma), the majority are malignant. Depending upon the specific subtype and stage, the 5-year survival exceeds 90–95 % in most studies. Importantly, there are currently more than 300,000 kidney cancer survivors in the USA. Given the excellent oncologic outcomes for a majority of patients with renal cell cancer (RCC), it is critical that care of these patients move beyond therapy that addresses the malignancy to those issues that affect long-term mortality and morbidity. In this population, chronic kidney disease (CKD), due to both underlying conditions as well as loss of renal mass, has become a key determinant of long-term outcomes.


Renal cell carcinoma Nephrectomy Chronic kidney disease Progression Partial nephrectomy ESKD 

List of Abbreviations


Chronic kidney disease


European Organization for Research and Treatment of Cancer


End stage kidney disease


Glomerular filtration rate


Renal cell cancer


  1. 1.
    US National Cancer Institute. Kidney cancer. Accessed: 19. Aug. 2013.
  2. 2.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.PubMedCrossRefGoogle Scholar
  3. 3.
    Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the national cancer data base. Cancer. 2008;113:78–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Pichler M, Hutterer GC, Chromecki TF, et al. Renal cell carcinoma stage migration in a single european centre over 25 years: effects on 5- and 10-year metastasis-free survival. Int Urol Nephrol. 2012;44:997–1004.PubMedCrossRefGoogle Scholar
  5. 5.
    Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170: 2217–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Schlomer B, Figenshau RS, Yan Y, Venkatesh R, Bhayani SB. Pathological features of renal neoplasms classified by size and symptomatology. J Urol. 2006;176:1317–20PubMedCrossRefGoogle Scholar
  7. 7.
    Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. 2010;183:473–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Campbell SC, Novick AC, Belldegrum A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG. Practice guidelines committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182:1271–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Ljungberg B, Cowan NC, Hanbury DC, et al. European Association of Urology. Guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010;58:398–406.PubMedCrossRefGoogle Scholar
  10. 10.
    Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PF, Belldegrum AS. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Novick AC. The role of renal-sparing surgery for renal cell carcinoma. Semin Urol. 1992;10:12–15.PubMedGoogle Scholar
  12. 12.
    Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stockle M. Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol 2006;49:1058–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow-up. J Urol. 2000;163:442–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Poppel H, Da Pozzo L, Albrecht W, Mateev V, Bono A, Borkowski A, Colombell M, Klotz L, Skinner E, Kean T, Marreaud S, Collette S, Sylvester R. A prospective, randomized EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59:543–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2013;pii:S0302-2838(13)00659–3. doi:10.1016/j.eururo.2013.06.044 [Epub ahead of print].Google Scholar
  16. 16.
    Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, Montorsi F, Russo P, Stockle M. Assessing the impact of ischemia time during partial nephrectomy. Eur Urol. 2009;625–34.Google Scholar
  17. 17.
    Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Patti MB, Campese V, Thangathurai D, Desai MM. “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol. 2011:59:128–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Atwell TD, Schmit GD, Boorjian SA, et al. Percutaneous ablation of renal masses measuring 3.0 cm and smaller: Comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol. 2013;200:461–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 2005;185:64–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA. Long-term oncologic outcomes after radiofrequency ablation for t1 renal cell carcinoma. Eur Urol. 2013;63:486–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Tan YK, Best SL, Olweny E, Park S, Trimmer C, Cadeddu JA. Radiofrequency ablation of incidental benign small renal mass: outcomes and follow-up protocol. Urology. 2012;79:827–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Zagoria RJ, Pettus JA, Rogers M, Werle DM, Childs D, Leyendecker JR. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology. 2011;77:1393–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Leveridge MJ, Finelli A, Kachura JR, et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol. 2011;60:578–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Volpe A, Mattar K, Finelli A, et al. Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience. J Urol. 2008;180:2333–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Jewett MA, Mattar K, Basiuk J, et al. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol. 2011;60:39–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Smaldone MC, Kutikov A, Egleston BL, et al. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer. 2012;118:997–1006.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Ljungberg B, Campbell SC, Choi HY, Jacqmin D, Lee JE, Weikert S, Kiemeney LA. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60:615–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Henriksen KJ, Meehan SM, Chang A. Non-neoplastic renal diseases are often unrecognized in adult tumor nephrectomy specimens: a review of 246 cases. Am J Surg Pathol. 2007;31:1703–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Salvatore SP, Cha EK, Rosoff JS, Seshan SV. Nonneoplastic renal cortical scarring at tumor nephrectomy predicts decline in kidney function. Arch Pathol Lab Med. 2013;137:531–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Brennan JF, Stilmant MM, Babayan RK, Siroky MB. Acquired renal cystic disease: implications for the urologist. Br J Urol. 1991;67:342–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Truong LD, Krishnan B, Cao JT, Barrios R, Suki WN. Renal neoplasm in acquired cystic kidney disease. Am J Kidney Dis. 1995;26:1–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Klarenbach S, Moore RB, Chapman DW, Dong J, Braam B. Adverse renal outcomes in subjects undergoing nephrectomy for renal tumors: a population-based analysis. Eur Urol. 2011;59:333–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Sun M, Bianchi M, Hansen J, Trinh QD, Abdollah F, Tian Z, Sammon J, Shariat SF, Graefen M, Montorsi F, Perotte P, Karakiewicz PI. Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis. Eur Urol. 2012;62:696–703.PubMedCrossRefGoogle Scholar
  35. 35.
    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW. American Heart Association Council on Kidney in Cardiovascular Disease, HBPRCC, Epidemiology, Prevention: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology and Epidemiology and Prevention. Circulation. 2003;108:2154–69.PubMedCrossRefGoogle Scholar
  36. 36.
    Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188:51–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Algaba F, Delahunt B, Berney DM, et al. Handling and reporting of nephrectomy specimens for adult renal tumours: a survey by the european network of uropathology. J Clin Pathol. 2012;65:106–113.PubMedCrossRefGoogle Scholar
  38. 38.
    Srigley JR, Amin MB, Delahunt B, et al. Protocol for the examination of specimens from patients with invasive carcinoma of renal tubular origin. Updated July 2012. Accessed: 31. Aug. 2013.
  39. 39.
    Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nose V. Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Path. 2006;30:575–84.PubMedCrossRefGoogle Scholar
  40. 40.
    Salvatore SP, Cha EK, Rosoff JS, Seshan SV. Nonneoplastic renal cortical scarring at tumor nephrectomy predicts decline in kidney function. Arch Path Lab Med. 2013;137:531–40.PubMedCrossRefGoogle Scholar
  41. 41.
    Gautam G, Lifshitz D, Shikanov S, Moore JM, Eggener SE, Shalhav AL, Chang A. Histopathological predictors of renal function decrease after laparoscopic radical nephrectomy. J Urol. 2010;184:1872–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.University of Virginia Health SystemCharlottesvilleUSA

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