632 SURVEILLANCE OF RENAL FUNCTION AFTER (PARTIAL) TUMOR NEPHRECTOMY BY CYSTATIN C- MEASUREMENT

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (I)1 Apr 2013632 SURVEILLANCE OF RENAL FUNCTION AFTER (PARTIAL) TUMOR NEPHRECTOMY BY CYSTATIN C- MEASUREMENT Marianne Schmid, Brigitte Schwaiger, Werner Tenschert, Marc Shaffu, Rana Thabaz, Jessica Langetepe, Sascha Ahyai, Christian Eichelberg, Margit Fisch, and Felix KH Chun Marianne SchmidMarianne Schmid Hamburg, Germany More articles by this author , Brigitte SchwaigerBrigitte Schwaiger Hamburg, Germany More articles by this author , Werner TenschertWerner Tenschert Hamburg, Germany More articles by this author , Marc ShaffuMarc Shaffu Hamburg, Germany More articles by this author , Rana ThabazRana Thabaz Hamburg, Germany More articles by this author , Jessica LangetepeJessica Langetepe Hamburg, Germany More articles by this author , Sascha AhyaiSascha Ahyai Hamburg, Germany More articles by this author , Christian EichelbergChristian Eichelberg Hamburg, Germany More articles by this author , Margit FischMargit Fisch Hamburg, Germany More articles by this author , and Felix KH ChunFelix KH Chun Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial (PN) or radical tumor nephrectomy (RN) patients are at risk for acute kidney injury (AKI) and consequently face further potential deterioration of renal function (RF) to chronic kidney disease (CKD). The routine serum creatinine (SCr) measurement has specific limitations especially in the “SCr blind range” (eGFR between 60-90 ml/min/1.73m2). Serum Cystatin C (SCysC) potentially provides a more accurate estimation of GFR. We addressed SCysC as a renal function parameter after PN and RN. METHODS Since January 2011, we prospectively investigated 31 patients with a preoperative GFR > 60 ml/min/1.73m2 undergoing PN or RN. SCr and SCysC, eGFR and SCysC-based cGFR were performed the day before intervention (-1), the first day after (partial) nephrectomy (+1) and at 1 year follow-up (FU). RESULTS Our cohort consisted of 20 (65%) men and 11 (35%) women. Mean FU was 13.4 months. Expectedly, RN impacted decrease of eGFR/cGFR in a stronger fashion at day +1 (p>0.05/ p=0.001) and 1 year FU (p<0.001/p=0.003) than PN. At day +1 and 1 year FU, 58 vs. 19% and 36 vs. 55% had significant elevation over normal range (onr) based on SCr vs. SCysC measurements (p<0.001). Pathologic SCr elevation on day +1 was significantly correlated with an elevation onr at 1 year FU (p=0.005). Similarly, pathologic SCysC elevation on day +1 was significantly correlated with a pathologically increased SCysC and SCr at 1 year FU (p=0.02 and 0.03). Specifically, 58% of patients were pre-operatively classified in the so-called “SCr blind range” (61% RN, 39% PN). At 1 year FU, an eGFR <60 (CKD stage III) was identified in 55 and 57% after RN and PN, respectively. Interestingly, a cGFR <60 was not detected. According to RN vs. PN, eGFR and cGFR was 60-90 in 45 vs. 14% and 82 vs. 29%. After RN 0% had an eGFR >90, but 29% of PN patients. Conversely after RN vs. PN, cGFR >90 was present in 18 vs. 57%. Correlation coefficients comparison was superior for SCysC to cGFR vs. SCr to eGFR (RN: R2=0.99 vs. 0.62; PN: R2=0.99 vs. 0.49). CONCLUSIONS Patients undergoing (partial) tumor nephrectomy are at severe risk of RF deterioration immediately post-op and at 1-year FU. Clearly, PN has a protective effect. Estimation of GFR appears superior based on SCysC in patients in the creatinine-blind range. Therefore, SCysC and cGFR may be used as complementary parameters to more accurately assess RF in the follow up after renal surgery. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e258 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marianne Schmid Hamburg, Germany More articles by this author Brigitte Schwaiger Hamburg, Germany More articles by this author Werner Tenschert Hamburg, Germany More articles by this author Marc Shaffu Hamburg, Germany More articles by this author Rana Thabaz Hamburg, Germany More articles by this author Jessica Langetepe Hamburg, Germany More articles by this author Sascha Ahyai Hamburg, Germany More articles by this author Christian Eichelberg Hamburg, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Felix KH Chun Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...