MP41-04 PREOPERATIVE PROTEINURIA IS ASSOCIATED WITH WORSE RENAL OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PARTIAL NEPHRECTOMY

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INTRODUCTION AND OBJECTIVES: Proteinuria is considered an important prognostic indicator for progression of chronic kidney disease (CKD) and mortality. Our goal was to investigate the significance of preoperative proteinuria in a cohort of patients without preexisting CKD undergoing elective partial nephrectomy (PN) for T1a tumors. METHODS: We reviewed a prospectively collected IRB approved database of 837 patients undergoing nephrectomy between 1/2007 and 12/2014, at our institution. Patients with preoperative GFR >60ml/min/1.73m and available preoperative urinalysis receiving elective PN for a pathologic T1a tumor were included. Proteinuria was defined as 30mg/dL. Postoperative GFR was measured at a minimum of 3 months. GFR categories were created based on Kidney Disease: Improving Global Outcomes guidelines. Demographic, tumor specific, and intraoperative characteristics as well as postoperative renal outcomes at last follow up were analyzed. RESULTS: We included 298 patients, 25 (8.4%) of whom had preoperative proteinuria, with a mean follow up of 34 months. There were no significant differences in age, BMI, comorbidities, operative time, EBL, ischemia time, or tumor size between the two groups. Patients with pre-existing proteinuria were more likely to be black (p1⁄40.02) and have a lower pre-op GFR (81.4 vs. 87.3 ml/min, p1⁄40.05). The mean decrease in GFR after PN in those with preoperative proteinuria was 19.7 vs. 9.4 ml/min in the control group (p1⁄40.01) (Table 1). After PN, 52% of patients in the proteinuria group developed CKD vs 13% in the group without proteinuria (p1⁄4<.001) (Table 2). CONCLUSIONS: In patients without pre-operative CKD undergoing elective PN, the presence of proteinuria is associated with larger decreases in GFR and higher probability of progression to CKD after surgery. Assessment of proteinuria preoperatively may aid in proper treatment selection for patients with small kidney tumors.