The screening for occult renal disease (SCORED) value is associated with a higher risk for having or developing chronic kidney disease in patients treated for small renal masses: Lucas SM, Nuss G, Stern J, Lotan Y, Sagalowsky AI, Cadeddu JA, Raj GV, Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX

Abstract

Patients with renal masses are at risk for having or developing chronic kidney disease (CKD) stage 3 glomerular filtration rate [GFR] < 60 mL/min/1.73 m(2). In this study, the authors investigated whether the screening for occult renal disease (SCORED) model could identify patients with renal masses who were at risk for having or developing CKD. Two hundred forty-two consecutive patients with unilateral T1a renal masses who underwent treatment were reviewed retrospectively. The GFR was estimated by using the Modification of Diet in Renal Disease equation. SCORED values were stratified as low (<4) or high (≥4). Kaplan-Meier survival curves (with log-rank comparison) were used to compute the risk of developing CKD. Before intervention, 65 of 242 patients (27%) with T1a renal masses had CKD, including 10 of 98 patients (10%) with low SCORED values and 55 of 144 patients (38%) with high SCORED values. Interventions included radical nephrectomy (RN) in 71 patients (29%) and nephron-sparing approaches (NSA) in 171 patients (71%). Among patients with normal preoperative renal function, those with low SCORED values were less likely to develop CKD than those with high SCORED values, whether they underwent RN (38% vs. 82%; P < 0.001) or NSA (14% vs. 22%; P = 0.01). Multivariate analyses revealed that high SCORED values (hazard ratio [HR], 2.9; P = 0.02) and RN (HR, 7.0; P < 0.001) were significant predictors of developing CKD. High SCORED values were associated with a higher risk for having or developing CKD in patients who underwent intervention for small, unilateral renal masses. These data suggest that NSA should be used whenever possible, and SCORED risk stratification should be used in counseling patients regarding their potential risk of CKD.