634 RISK FACTORS OF RENAL FUNCTION DETERIORATION AFTER (PARTIAL) TUMOR NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (I)1 Apr 2013634 RISK FACTORS OF RENAL FUNCTION DETERIORATION AFTER (PARTIAL) TUMOR NEPHRECTOMY Brigitte Schwaiger, Marianne Schmid, Werner Tenschert, Marc Shaffu, Rana Thabaz, Jessica Langetepe, Christian Eichelberg, Sascha Ahyai, Margit Fisch, and Felix KH Chun Brigitte SchwaigerBrigitte Schwaiger Hamburg, Germany More articles by this author , Marianne SchmidMarianne Schmid 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 , Christian EichelbergChristian Eichelberg Hamburg, Germany More articles by this author , Sascha AhyaiSascha Ahyai 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.2013.02.186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A reduction of renal mass due to partial (PN) or radical tumor nephrectomy (RN) is followed by substantial loss of renal function (RF). Within the course of follow-up (FU), these patients are at further risk for renal function deterioration and ultimately development of chronic kidney disease (CKD). This investigation aimed to identify risk factors for postoperative renal function deterioration in renal cell carcinoma (RCC) patients with a preoperative GFR > 60 ml/min/1.73m2. METHODS Since January 2011, renal functional data of 31 RCC patients undergoing PN or RN were prospectively investigated. Data consisted of serum creatinine (SCr), glomerular filtration rate (eGFR), serum Cystatin C (SCysC) and SCysC-based GFR (cGFR), clinical characteristics including body mass index (BMI), blood pressure, proteinuria, history of diabetes, blood lipid levels. Using univariable Cox regression analyses, these pre-op parameters were used to identify patients with a) an eGFR< 60 and b) the presence of a new onset arterial hypertonia (aHT). These endpoints served as proxies of FU renal function 1 year after surgery. RESULTS The cohort consisted of 20 (65%) men and 11 (35%) women aged 58 years (range 42 - 72). Mean follow-up (FU) was 13.4 months after PN (52%) or RN (48%). Preoperative baseline eGFR and cGFR was 85.9 and 109.6, respectively. Renal function risk factors, such as BMI > 30, aHT and proteinuria were present preoperatively in 16, 42 and 29%, respectively. At 1 year FU, BMI > 30, proteinuria, HbA1c levels > 6% and hypercholesterolemia was present in 32, 29, 35 and 65%, respectively, and 31% presented a new onset aHT. Expectedly, at 1 year post-OP FU, eGFR vs. cGFR significantly decreased (-15.5 vs. -19.8; p<0.001) compared to pre-OP measurements. Further, 71% demonstrated an eGFR < 60. In univariable analyses, significant risk factors for a) an eGFR < 60 at FU were a pathologically elevated SCr the first postoperative day (p=0.018, OR=8,64) and the surgical procedure (PN vs. RN, p=0.054, OR=0.22) and b) new onset aHT was the age at operation (p=0.031, OR=1.25). A SCysC elevation over normal range the first day following RN/PN was not significantly associated to the chosen outcomes. CONCLUSIONS Patients undergoing (partial) tumor nephrectomy demonstrate severe RF deterioration in the 1-year FU. Early management of pre-existing risk factors such as type of surgery and early change in SCr, as well as aHT and control of body weight are essential for postoperative RF outcome. Since in the 1 year FU, RF is still decreasing attentive after-care to avoid further renal function deterioration is warranted. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e259 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brigitte Schwaiger Hamburg, Germany More articles by this author Marianne Schmid 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 Christian Eichelberg Hamburg, Germany More articles by this author Sascha Ahyai 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 ...