1677 NATURAL HISTORY OF RENAL FUNCTION IN UNTREATED KIDNEY CANCER

Abstract

You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 20121677 NATURAL HISTORY OF RENAL FUNCTION IN UNTREATED KIDNEY CANCER Ashraf Almatar, David Margel, Antonio Finelli, Hannah Chung, Neil Fleshner, Alexandre Zlotta, Laura Legere, Henry Ajzenberg, and Michael Jewett Ashraf AlmatarAshraf Almatar Toronto, Canada More articles by this author , David MargelDavid Margel Toronto, Canada More articles by this author , Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author , Hannah ChungHannah Chung Toronto, Canada More articles by this author , Neil FleshnerNeil Fleshner Toronto, Canada More articles by this author , Alexandre ZlottaAlexandre Zlotta Toronto, Canada More articles by this author , Laura LegereLaura Legere Toronto, Canada More articles by this author , Henry AjzenbergHenry Ajzenberg Toronto, Canada More articles by this author , and Michael JewettMichael Jewett Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1550AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic kidney disease (CKD) is an increasing health problem and we now appreciate its relationships with kidney cancer. Many patients presenting with renal cell carcinoma (RCC) have pre-existing renal impairment and surgical or ablative treatment has been documented to cause further loss of function. However, the natural history of renal function in patients with untreated localized RCC has not been well documented. This would provide a new baseline for measuring the impact of kidney cancer therapy on renal function. Our objective is to establish the natural history of renal function in patients who are managed by active surveillance (AS) for T1a RCC. METHODS 45 patients with localized sporadic biopsy-proven RCC < 4 cm managed by AS were retrospectively identified from May 2003 to September 2010. Patients all had baseline estimated glomerular filtration rate (eGFR)> 60 ml/min/1.73 m2 and normal contralateral kidney function. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The rate of developing eGFR <60 ml/min/1.73 m2 was calculated. Kaplan-Meier analysis was used to estimate the percentage of freedom from CKD stage 3 at follow-up. RESULTS Median follow up was 26(IQR12-43) months. Median age was 68(59-75) years. The median baseline eGFR was 81(74-91) ml/min/1.73 m2. 12 (27%) patients had an eGFR > 90 (CKD stage 1) and 33 (73%) patients had an eGFR between 60 and 89 (CKD stage 2). 8 patients (17.8%) had eGFR <60 (CKD stage 3) by the end of follow-up. The 3 year freedom from eGFR < 60 ml/min/1.73m2 in this cohort of patients is 80%. In the group of patients > 65 years old (26 out of 45 or 58%), 5 out of 26 patients (19%) had CKD stage 3 at the end of follow-up with a 75% 3-year freedom from eGFR < 60 ml/min/1.73m2. CONCLUSIONS This is the first study, to our knowledge, to report the natural history of renal function in a cohort of biopsy-proven RCC patients undergoing AS. RCC patients may be at a higher risk for the development of renal dysfunction. The rate established in this study can be used in the future to compare with the rate of eGFR decline in patients who have undergone surgical or ablative treatment for RCC, and to assess the actual impact of these treatments on renal function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e677-e678 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashraf Almatar Toronto, Canada More articles by this author David Margel Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Hannah Chung Toronto, Canada More articles by this author Neil Fleshner Toronto, Canada More articles by this author Alexandre Zlotta Toronto, Canada More articles by this author Laura Legere Toronto, Canada More articles by this author Henry Ajzenberg Toronto, Canada More articles by this author Michael Jewett Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...