PD40-05 RECOVERY OF RENAL FUNCTION FOLLOWING PN IN SOLITARY KIDNEY: IMPACT OF PRE-OPERATIVE EGFR AND INTRAOPERATIVE CHARACTERISTICS ON RECOVERY OF RENAL FUNCTION

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD40-05 RECOVERY OF RENAL FUNCTION FOLLOWING PN IN SOLITARY KIDNEY: IMPACT OF PRE-OPERATIVE EGFR AND INTRAOPERATIVE CHARACTERISTICS ON RECOVERY OF RENAL FUNCTION Arnold Oparanozie, Stephen W. Reese, Stanley Weng, Lennert Eismann, Katiana Vasquez-Rivera, Jonathan Coleman, A. Ari Hakimi, and Paul Russo Arnold OparanozieArnold Oparanozie More articles by this author , Stephen W. ReeseStephen W. Reese More articles by this author , Stanley WengStanley Weng More articles by this author , Lennert EismannLennert Eismann More articles by this author , Katiana Vasquez-RiveraKatiana Vasquez-Rivera More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , A. Ari HakimiA. Ari Hakimi More articles by this author , and Paul RussoPaul Russo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients undergoing surgery for a renal mass in a solitary kidney, it remains unknown the extent of acute kidney injury (AKI), post-operative renal recovery, and role for large renal tumors (>T2b) in patients undergoing surgery for renal masses in a solitary kidney. Thus, we explored the clinical outcomes and post-operative renal function in a cohort of patients undergoing renal-sparing surgery. METHODS: This study was a single-center retrospective analysis of patients undergoing renal sparing surgery in a solitary kidney at a high-volume academic institution. Descriptive statistics were captured and compared using a Chi-squared test and Wilcoxon Rank Test for categorical and continuous variables, respectively. Multivariable regression was performed using a least-square estimates linear regression model. Survival analysis was performed using the Kaplan-Meier method. RESULTS: In total, 148 patients underwent a partial nephrectomy in a solitary kidney. Most patients were male [110 (74.3%)], 20 (13.5%) had diabetes and 96 (64.9%) had hypertension. The cause of a solitary kidney was a prior history of nephrectomy for carcinoma (n=137, 92.6%). The time from prior nephrectomy to secondary nephrectomy was 77.9 mo (IQR: 14.1-157.2) and median pre-operative eGFR was 52.1 (IQR: 43.7 – 64.7). Most patients had a complex renal mass with 77 (52.0%) having a RENAL score greater than 7. Most patients were clinical stage T1/2 (n=119, 80.4%), however 27 (18.2%) had a T3 tumor. Most patients underwent an open procedure (n=132, 89.2%), had an on-clamp partial (n=92, 62.2%) and had cold ischemia (n=68, 73.9%). The median clamp time was 36 min (IQR: 26-47). eGFR was measured in the 12 months after surgery and after an initial decline in eGFR, there was noted to be recovery of renal function. In our multi-variable model, there was no differences in change from baseline eGFR at 12 months, including starting eGFR, cold vs. warm ischemia time and on-clamp vs. off-clamp partial nephrectomy. Dialysis was required in 14 (9.5%) patients and of those who required dialysis, 8 (57.1%) only had temporary dialysis, while in 6 (42.9%) dialysis was permanent. Median OS was 118.3 mo (95% CI: 138.8 -106.2). At the end of follow-up, 69 (46.6%) had died and of those 27 (39.1%) died of kidney cancer. Of those who died of kidney cancer, 7 (25.9%) had clinical stage T3 at time of surgery. CONCLUSIONS: In this selected cohort of renal masses in solitary kidneys, nephron-sparing surgery was feasible with most patients recovering to baseline GFR regardless of approach. Source of Funding: MSK P30 grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1053 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arnold Oparanozie More articles by this author Stephen W. Reese More articles by this author Stanley Weng More articles by this author Lennert Eismann More articles by this author Katiana Vasquez-Rivera More articles by this author Jonathan Coleman More articles by this author A. Ari Hakimi More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF downloadLoading ...