Abstract
The objective of this review is to evaluate the factors that determine the development or deterioration of Chronic Kidney Disease (CKD) after partial nephrectomy (PN).When current literature is reviewed, it is found that factors that influence renal function after partial nephrectomy, are multifactorial. Those are divided into pre-surgical factors, such as hypertension, diabetes mellitus, urolithiasis, obesity, metabolic syndrome among others; intra-surgical factors, like the surgical technique used, the remaining healthy tissue, the experience of the surgeon, the time and type of ischemia among others. Lastly, post-surgical factors, also impose some influence on the post-surgical renal performance.It was also found that minimally invasive surgery, in addition to its known advantages, seems to offer a greater field of action in the future that will allow more nephrons preservation in any future surgical scenario.Finally, the current trend is to perform PN on all patients, in whom surgery is technically feasible regardless of the approach used, without risking oncological outcomes, patient safety, and without being exposed to any additional complications.
Highlights
Sparing most of the nephrons without compromising the oncological outcome has played an important role in the kidney malignancies management
The current trend to manage most renal masses using the partial nephrectomy (PN) technique or nephron-sparing surgery has provided a better understanding of chronic kidney disease (CKD) physiopathology in patients that underwent these surgical interventions
Nephrologic and urologic diseases are not the only risk factors for CKD; hypertension, obesity, and smoking pose an increased risk for CKD (RCC) [5]. It is for this reason that CKD can be found in up to 26% of RCC patients with normal pre-surgical serum creatinine levels [6].For instance, A histologic evaluation of 110 patients, in whom radical nephrectomy was carried out, different histological changes were found on the tissues surrounding the tumor (such as vascular sclerosis, atheroembolic disease, and diabetic nephropathy (glomerular hypertrophy, mesangial expansion, and diffuse glomerulosclerosis. 6 months of follow-up after surgery, these patients experienced a significant decrease in the levels of renal function, when compared to those with normal tissue around tumor [7]
Summary
Sparing most of the nephrons without compromising the oncological outcome has played an important role in the kidney malignancies management. Partial nephrectomy (PN) has the advantage of maintaining or preserving as much kidney function as possible, ensuring greater survival and reduced morbidity. On this matter, two interesting concepts were proposed recently: trifecta (negative surgical margins, no postoperative complications and warm ischemia time of ≤ 25 minutes) and pentafecta (trifecta components plus: preservation of more than 90% of renal function and no presence of chronic kidney disease). The current trend to manage most renal masses using the PN technique or nephron-sparing surgery has provided a better understanding of chronic kidney disease (CKD) physiopathology in patients that underwent these surgical interventions. A total of 94 articles were identified for potential inclusion based on the review and were eligible for the qualitative analysis. This study was performed using guidelines set out by PRISMA (Preferred Reporting Items for Systematic Reviews and meta-analysis statement [3] (Figure 1.)
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