PD43-01 LINEAR MEASUREMENTS AT POINT OF CARE TO ESTIMATE SPLIT RENAL FUNCTION AND PREDICT FUNCTIONAL OUTCOMES AFTER RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD43-01 LINEAR MEASUREMENTS AT POINT OF CARE TO ESTIMATE SPLIT RENAL FUNCTION AND PREDICT FUNCTIONAL OUTCOMES AFTER RADICAL NEPHRECTOMY Nityam Rathi, Kieran Lewis, Worapat Attawettayanon, Carlos Munoz-Lopez, Yosuke Yasuda, Diego Aguilar Palacios, Jianbo Li, Nour Abdallah, Jared Schober, Marshall Strother, Alexander Kutikov, Robert Uzzo, Christopher Weight, Mohamed Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, and Steven Campbell Nityam RathiNityam Rathi More articles by this author , Kieran LewisKieran Lewis More articles by this author , Worapat AttawettayanonWorapat Attawettayanon More articles by this author , Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Jianbo LiJianbo Li More articles by this author , Nour AbdallahNour Abdallah More articles by this author , Jared SchoberJared Schober More articles by this author , Marshall StrotherMarshall Strother More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Christopher WeightChristopher Weight More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While radical nephrectomy (RN) is an important consideration for renal tumors with increased complexity and oncologic potential, reduced postoperative new baseline GFR (NBGFR) relative to partial nephrectomy (PN) remains a concern. Thus, accurate predictions of NBGFR after RN can have clinical implications for RCC management, particularly in challenging cases where RN/PN offer distinct merits. Preoperative global GFR, split renal function (SRF), and renal functional compensation (RFC) in the contralateral kidney have been shown to be fundamental parameters for the accurate prediction of NBGFR after RN. While SRF has traditionally been obtained from nuclear renal scans (NRS), recent studies suggest that software-derived differential parenchymal volume analysis (PVA) is more accurate.1 A simplified approach to estimate SRF based on linear length/width/height measurements (LWH) has also been proposed.2 In this study, we compare the accuracies of each of these three methods for determining SRF, and, by extension, predicting NBGFR. METHODS: All 235 RCC patients managed with RN (2006-21) with preoperative CT/MRI, NRS, and preoperative and postoperative GFR data were included. PVA was performed on CT/MRI using a 3D imaging software (Figure 1A-C), and LWH (Figure 1D-G) measurements were obtained using basic tools in the CT/MRI user interface. NBGFR was defined as the GFR 3-12 months after RN, and RFC was approximated at 25% based on prior studies (Predicted NBGFR=1.25×Global GFRPre-RN×SRFContralateral). Predictive accuracies were assessed by correlation coefficients (r) and mean-squared errors. RESULTS: The r values for the LWH-, NRS-, and PVA-based approaches were 0.72, 0.71, and 0.86, respectively (Figure 1H-J). Differences in predictive accuracies of the PVA-based and non-PVA-based approaches were statistically significant. CONCLUSIONS: Software-derived PVA provides the most precise and accurate estimations of SRF, and thus NBGFR after RN, when compared to NRS and LWH methods. Clinically, the PVA-based approach can readily provide accurate predictions of NBGFR in challenging RCC cases where RN is a relevant consideration. Furthermore, the LWH approach, which can also be performed at point of care, is equivalent to NRS, precluding the need for NRS in most patients. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1117 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nityam Rathi More articles by this author Kieran Lewis More articles by this author Worapat Attawettayanon More articles by this author Carlos Munoz-Lopez More articles by this author Yosuke Yasuda More articles by this author Diego Aguilar Palacios More articles by this author Jianbo Li More articles by this author Nour Abdallah More articles by this author Jared Schober More articles by this author Marshall Strother More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Christopher Weight More articles by this author Mohamed Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...