Analysis of risk factors for acute kidney injury after radical nephrectomy

Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomy

Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

Surgically Induced Chronic Kidney Disease May be Associated with a Lower Risk of Progression and Mortality than Medical Chronic Kidney Disease

Chronic Kidney Disease in Patients With Renal Cell Carcinoma

Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma

Factors Predicting Renal Functional Outcome After Partial Nephrectomy

Management of the Adrenal Gland During Partial Nephrectomy

We sought to investigate the association between intraoperative urine output and postoperative acute kidney injury (AKI) in patients undergoing radical and partial nephrectomy. We retrospectively reviewed data of 742 patients. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. The relationship between intraoperative urine output and the risk of AKI was evaluated by multivariable logistic regression analysis in radical and partial nephrectomy, separately. Minimum P-value approach was used to find the optimal threshold of intraoperative oliguria associated with the risk of AKI. The incidence of AKI was 14.4% (67/466) after partial nephrectomy and 57.6% (159/276) after radical nephrectomy. For partial nephrectomy, multivariable analysis showed that renal ischemic time, operation time, open surgery and intraoperative transfusion were significantly associated with AKI. For radical nephrectomy, history of hypertension, baseline glomerular filtration rate and intraoperative mean urine output were significantly associated with AKI. Intraoperative mean urine output during radical nephrectomy was associated with AKI after radical nephrectomy, while not after partial nephrectomy. Mean urine output <1.0 mL/kg/h was determined to be an optimal cutoff of AKI after radical nephrectomy. Intraoperative oliguria may have different clinical implication for AKI between partial and radical nephrectomy.

Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? At present, many studies have been executed to identify predictors for chronic kidney disease or renal insufficiency after radical nephrectomy or partial nephrectomy. We examined whether preoperative kidney volume is a predictor for renal function after radical or partial nephrectomies in RCC patients. To our knowledge, this is the first study to report on the relationship between preoperative kidney volume and changes in renal function in RCC patients who underwent radical nephrectomy or partial nephrectomy performed by one surgeon. To investigate whether preoperative kidney volume is a prognostic factor for predicting the postoperative glomerular filtration rate (GFR) in renal cell carcinoma (RCC) patients. We included 133 patients who underwent radical (n= 83) or partial (n= 50) nephrectomy for RCC. Kidney parenchymal volume was measured using personal computer-based software and GFR was estimated before and after surgery at 6 and 12 months. We evaluated the change in kidney volume after radical and partial nephrectomy and used regression analysis to identify predictors of lower post-surgical GFR at 12 months. The mean volume of the normal side kidney for the radical nephrectomy group increased from 142.4 mL to 166.0 mL (17.2%) and 171.5 mL (21.2%) after surgery at 6 and 12 months, respectively. In the partial nephrectomy group, the volume of the normal side kidney increased from 127.2 mL to 138.8 mL (9.1%) and 140.6 mL (10.9%) after surgery at 6 and 12 months, respectively. The volume of the operated side kidney decreased from 128.5 mL to 102.3 mL (20.1%) and 101.8 (20.6%) after surgery at 6 and 12 months, respectively. In the radical nephrectomy group, older age (P < 0.001), preoperative volume of the normal kidney (P= 0.022) and preoperative GFR for the normal side kidney (P= 0.045) were significant predictors of lower post-surgical GFR at 12 months. In the partial nephrectomy group, older age (P= 0.001) and preoperative volume for both kidneys (P= 0.037) were significant predictors of lower post-surgical GFR at 12 months. Preoperative kidney volume is an independent predictor of GFR in RCC patients who underwent radical or partial nephrectomy.

Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma

Female gender is known to be protective against acute kidney injury (AKI) after radical or partial nephrectomy and estrogen is considered a protective factor. If estrogen is a major contributor to the protective effects of female gender against renal injury, these protective effects may be diminished in postmenopausal women. Therefore, this retrospective study investigated the influence of female age on gender-related differences in AKI after minimally invasive radical or partial nephrectomy. Patients who underwent minimally invasive radical (n = 765) or partial (n = 1161) nephrectomy were selected. These patients were stratified by gender and divided into three age categories considered to be pre, peri, and postmenopausal periods in women: ≤ 40years, 41-59years, and ≥ 60years, respectively. Adjusted logistic regression analyses were conducted to identify the risk of AKI according to gender and age. The incidence of AKI after radical or partial nephrectomy was significantly higher in men as compared to women in all age categories. Women aged ≥ 60years had a significantly increased risk of AKI as compared to women aged < 60years in radical nephrectomy, but not in partial nephrectomy. When compared with women aged ≥ 60years, men aged > 40years accompanied significantly higher risk of AKI following both radical and partial nephrectomy, even after adjusting confounders. However, men aged ≤ 40years had a similar risk of AKI after radical nephrectomy, but a significantly higher risk after partial nephrectomy as compared to women aged ≥ 60years. Male gender was associated with a higher risk of AKI after radical and partial nephrectomy as compared to postmenopausal women. This calls for more thorough preoperative counseling and renal protective strategies in male patients when undergoing radical and partial nephrectomy.

Renal Cell Carcinoma in Young and Old Patients—Is There a Difference?

Acute kidney injury after partial or radical nephrectomy remains an unsolved problem even when using minimally invasive techniques. We aimed to identify risk factors for acute kidney injury (AKI) after minimally invasive nephrectomy and to develop a clinical risk scoring system. Medical records of 1762 patients who underwent minimally invasive laparoscopic or robot-assisted laparoscopic partial (n = 1009) or radical (n = 753) nephrectomy from December 2005 to November 2018 were reviewed. Candidate risk factors were screened using univariate analysis and ranked using linear discriminant analysis; top ranking factors were incorporated into a multivariate logistic regression model. Then, the final clinical scoring system was created based on the estimated odds ratios. The incidence of acute kidney injury after partial or radical nephrectomy was 20.3 and 61.6%, respectively. Risk factors incorporated into the scoring system included: size of the parenchymal mass removed (3 < parenchymal mass ≤ 4cm, 1 point; 4 < parenchymal mass ≤ 6cm, 3 points; parenchymal mass > 6cm, 5 points), male sex (2 points), diabetes mellitus (1 point), warm ischemia time ≥ 25min (1 point), and immediate postoperative neutrophil count ≥ 12,000µl-1 (1 point) in patients with partial nephrectomy, and sex (male, 10 points; female, 7 points) in patients with radical nephrectomy. For risk scores of 0-4, 5-6, 7, 8-9, and 10 points, the probabilities of acute kidney injury were approximately 10, 20, 40, 60, and 80%, respectively. The predictive accuracy of the scoring system was 0.827 (95% CI 0.789-0.865). Our risk scoring system could help clinicians identify those at risk of acute kidney injury after minimally invasive partial or radical nephrectomy, thereby optimizing postoperative management.

Guideline for Management of the Clinical T1 Renal Mass