Predictors Of Renal Function Research Articles

Early Metabolomic Profiling as a Predictor of Renal Function Six Months After Kidney Transplantation.

Kidney transplantation is the therapy of choice for patients with advanced chronic kidney disease; however, predicting graft outcomes remains a significant challenge. Early identification of reliable biomarkers could enhance post-transplant management and improve long-term outcomes. This study aimed to identify metabolomic biomarkers within the first week after kidney transplantation that predict renal function at six months. We conducted a prospective study involving 50 adult patients who received deceased donor kidney transplants. Plasma samples collected one week after transplant were analyzed using liquid chromatography-mass spectrometry in a semi-targeted metabolomic approach. A Partial Least Squares-Discriminant Analysis (PLS-DA) model identified metabolites associated with serum creatinine > 1.5 mg/dL at six months. Metabolites were selected based on a Variable Importance in Projection (VIP) score > 1.5, which was used to optimize model performance. The PLS-DA model demonstrated strong predictive performance with an area under the curve (AUC) of 0.958. The metabolites negatively associated with serum creatinine > 1.5 mg/dL were 3-methylindole, guaiacol, histidine, 3-indolepropionic acid, and α-lipoic acid. Conversely, the metabolites positively associated with worse kidney graft outcomes included homocarnosine, 5-methylcytosine, xanthosine, choline, phenylalanine, kynurenic acid, and L-kynurenine. Early metabolomic profiling after transplantation shows promise in predicting renal function. Identifying metabolites with antioxidant and anti-inflammatory properties, as well as those that are harmful and could be targeted therapeutically, underscores their potential clinical significance. The link between several metabolites and the tryptophan pathway suggests that further specific evaluation of this pathway is warranted. These biomarkers can enhance patient management and graft survival.

Comparison of absolute renal uptake by using Tc-99m MAG-3 and Tc-99m DMSA.

The purpose of this study is to compare the value of absolute renal uptake (ARU %) in patients by using Tc-99m MAG-3 and Tc-99m DMSA scan. Absolute renal uptake is calculated using Tc-99m MAG-3 and Tc-99m DMSA in renal scintigraphy, Itoh and Tauex kidney depth methods used, respectively. n = 40 adult patients of both genders were included. All patients underwent Tc-99m MAG-3 and Tc-99m DMSA, respectively. The values of ARU (%) were calculated separately in selected patients n = 40, (left = 17, right = 23 normal functioning kidneys) by MAG-3 and DMSA. Absolute renal uptake (%) of Tc-99m MAG-3 in left kidneys was found to be 15.2 ± 3.4, with spilt renal function 79.2 ± 14.7 and ARU (%) in right kidneys 16.2 ± 3.4 with spilt renal function 77.5 ± 19. Absolute renal uptake of Tc-99m DMSA in left kidneys was 17.5 ± 3.2 and in right kidneys 17.9 ± 4.5 with spilt renal function 81.8 ± 10.7 and 79.3 ± 13.8 for left and right kidney, respectively. Statistical analysis showed strong Pearson correlation. Absolute renal uptake % was found to be more reliable in cases of bilateral compromised kidneys. ARU (%) calculated by Tc-99m MAG-3 solely can be used as predictor of renal function. The use of Tc-99m MAG-3 has more advantages than Tc-99m DMSA alone in renal scintigraphy as dynamic scintigraphy gives less radiation burden to patient, more information regarding renal function, and shorter stay time at hospital in comparison to static renal imaging. SRF % is less reliable than ARU (%).

Cystatin C as a Predictor of Renal Function and Methotrexate-Associated Toxicities in Patients With Rheumatoid Arthritis.

Methotrexate (MTX) is an anchor drug for most patients with rheumatoid arthritis (RA); however, its use may be limited depending on renal function. Therefore, this study aimed to examine the discrepancy in the estimated glomerular filtration rate (eGFR) using conventional serum creatinine (SCr)-, cystatin C-, and MTX-associated toxicities in patients with RA. In total, 436 patients were enrolled, and eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on both cystatin C and SCr levels. The CKD and MTX dosing stages were classified according to eGFR. MTX-associated toxicities were also evaluated. The mean eGFR using CKD-EPI cystatin C (CKD-EPIcys) was 89.44 mL/min/1.73 m2, lower than the eGFR using CKD-EPI SCr (CKD-EPISCr) of 95.55 mL/min/1.73 m2. After converting eGFR to CKD-EPIcys by CKD-EPISCr, 29.8% of patients were reclassified to a higher stage according to the Kidney Disease: Improving Global Outcomes CKD stage. Also, according to the MTX guidelines, 6.4% of the group with an eGFR > 50 mL/min/1.73 m2 were reclassified to eGFR 10-50 mL/1.73 m2, requiring dose adjustment. The incidence of MTX-associated toxicities, such as anemia, leukopenia, and nephrotoxicity, was significantly higher in the CKD stage-changed group than in the nonstage-changed group. Our results showed that eGFR based on SCr was overestimated compared with eGFR based on cystatin C. In addition, we demonstrated that MTX-associated toxicities were significantly increased in the group with a changed stage when the eGFR was converted from CKD-EPISCr to CKD-EPIcys.

Evaluation of glomerular hyper filtration in obesity: Which formula to use?

Introduction: Obesity is a progressive chronic disease that is a renal risk factor. Renal hyperfiltration is an early stage in the development of chronic kidney disease (CKD). The objective of our study is to determine the prevalence of glomerular hyperfiltration in obese patients. Materials and Methods: This is a prospective and descriptive study conducted over a period of 4 months. All patients with BMI over 30 kg/m2 who do not have diabetes, hypertension or another apparent cause of CKD. Results: A total of 85 patients were included, the mean age was 41.96 years, with a female majority. The mean BMI was 38.24kg/m2 and the mean abdominal waist circumference was 114.57cm. Obesity was common in 55.88% and secondary in 44.11%. The prevalence of glomerular hyperfiltration was 85.18% by Cockcroft formula and 48.33% by MDRD formula. Discussion: Obesity is a risk factor for CKD, which promotes increased renal blood flow by vasodilation of the afferent glomerular arteriole, resulting in glomerular hyperfiltration that leads to a change in the glomerular barrier, increasing the risk of developing CKD. According to several studies, the Cockcroft formula is a better predictor of renal function in obese patients. A 51% increase in GFR in obese patients has been observed. In our study, the prevalence of glomerular hyperfiltration is 85.18% according to the Cockcroft formula. Conclusion: Obesity is a risk factor for CKD that needs to be carefully considered.

U-KIM-1 as a predictor of treatment response in lupus nephritis.

Biomarkers of disease activity in lupus nephritis (LN) are in demand. This is because they may be useful in patients who are unable to undergo invasive kidney biopsy, as predictors of renal function, and for early detection of LN recurrence. The focus is on the measurement of urinary chemokines and cytokines, especially in urinary biomarkers, which are non-invasive and simple. In our previous report, we reported that kidney injury molecule-1 (KIM-1) is expressed in injured tubules and that the number of tubular-KIM-expressing positive cells correlates with renal pathology findings and also with urinary (u)-KIM-1 levels. However, there have been no reports examining the effect of u-KIM-1 levels on response to therapy, correlation with renal pathology, and usefulness as a predictor of renal function. U-KIM-1 levels were measured by ELISA in 61 SLE patients. In 38 active LN who underwent renal biopsy, we also examined whether u-KIM-1 levels affected LN disease activity, renal histological findings, and predictors of renal function. In SLE patients, proteinuria and u-KIM-1 levels were elevated in active LN compared to inactive LN. U-KIM-1 and proteinuria decreased with intensified treatment. U-KIM-1 levels also correlated with the percentage of glomerular crescent formation in renal pathology. In addition, patients with higher baseline u-KIM-1 levels had significantly higher eGFR and lower LN disease activity at 12months after treatment intensification. These data suggest that u-KIM-1 levels correlate with LN disease activity and renal histopathology findings and may be used as a predictor of treatment response.

Predictors of renal function after adrenalectomy in patients with Cushing or subclinical Cushing syndrome.

The postoperative course of renal function remains unclear in Cushing syndrome. We examined changes in renal function after adrenalectomy in patients with Cushing syndrome and attempted to identify predictors of renal impairment. The study population comprised 76 patients who underwent adrenalectomy for Cushing and subclinical Cushing syndrome between 2001 and 2018. Renal function and other factors were evaluated pre-operation, at 1 postoperative month, and 1 postoperative year. We defined a ≥10% decrease in the estimated glomerular filtration rate at 1 postoperative year as renal impairment, and predictors associated with this reduction were investigated. The relationship between renal function and steroid replacement after surgery was also examined. Mean pre-operative estimated glomerular filtration rate was 82.2 ml/min/1.73 m2 . While mean estimated glomerular filtration rate was significantly lower at 1 postoperative month than the pre-operative value (71.7 ml/min/1.73 m2 [89.1%], p < 0.001), no significant differences were observed between 1 postoperative year and pre-operation (79.5 ml/min/1.73 m2 [97.6%], p = 0.108). Twenty-six patients (34.2%) developed renal impairment. A multivariate analysis identified a low pre-operative adrenocorticotropic hormone level as an independent predictor of renal impairment (odds ratio 6.30, p = 0.031). Among 43 patients with available records of steroid replacement history, 18 (41.9%) developed renal impairment. The ratio of patients with a reduced steroid replacement dose at 1 postoperative month was significantly lower among patients with renal impairment than those without (22.2% vs. 56.0%, p = 0.027). The pre-operative adrenocorticotropic hormone level was a predictor of renal function after adrenalectomy in patients with Cushing or subclinical Cushing syndrome.

Abstract 23 - Size does not matter; Skeletal muscle index is not a predictor of renal function following living donor nephrectomy

Abstract 23 - Size does not matter; Skeletal muscle index is not a predictor of renal function following living donor nephrectomy

Advanced glycation end products as predictors of renal function in youth with type 1 diabetes

To examine if skin autofluorescence (sAF) differed in early adulthood between individuals with type 1 diabetes and age-matched controls and to ascertain if sAF aligned with risk for kidney disease. Young adults with type 1 diabetes (N = 100; 20.0 ± 2.8 years; M:F 54:46; FBG-11.6 ± 4.9 mmol/mol; diabetes duration 10.7 ± 5.2 years; BMI 24.5(5.3) kg/m2) and healthy controls (N = 299; 20.3 ± 1.8 years; M:F-83:116; FBG 5.2 ± 0.8 mmol/L; BMI 22.5(3.3) kg/m2) were recruited. Skin autofluorescence (sAF) and circulating AGEs were measured. In a subset of both groups, kidney function was estimated by GFRCKD-EPI CysC and uACR, and DKD risk defined by uACR tertiles. Youth with type 1 diabetes had higher sAF and BMI, and were taller than controls. For sAF, 13.6% of variance was explained by diabetes duration, height and BMI (Pmodel = 1.5 × 10–12). In the sub-set examining kidney function, eGFR and sAF were higher in type 1 diabetes versus controls. eGFR and sAF predicted 24.5% of variance in DKD risk (Pmodel = 2.2 × 10–9), which increased with diabetes duration (51%; Pmodel < 2.2 × 10–16) and random blood glucose concentrations (56%; Pmodel < 2.2 × 10–16). HbA1C and circulating fructosamine albumin were higher in individuals with type 1 diabetes at high versus low DKD risk. eGFR was independently associated with DKD risk in all models. Higher eGFR and longer diabetes duration are associated with DKD risk in youth with type 1 diabetes. sAF, circulating AGEs, and urinary AGEs were not independent predictors of DKD risk. Changes in eGFR should be monitored early, in addition to uACR, for determining DKD risk in type 1 diabetes.

Role of Computed Tomography in Estimation of Residual Renal Function at One Year after Donor Nephrectomy: Comparison with Nuclear Scintigraphy.

Computed tomography (CT) is routinely used for preoperative anatomical evaluation of renal donors, but recent studies show that it may be useful as a predictor of renal function too. This study aimed to compare CT volumetry-attenuation-based glomerular filtration rate (GFR) with Tc99m-diethylene-triamine-pentaacetic acid (DTPA) renal scintigraphy GFR and predict post-donor nephrectomy renal function. This is a prospective study involving 39 renal donors at a tertiary care hospital in northern India from 2014 to 2017. Renal volume and attenuation were determined by CT using a semiautomatic tool, and split renal function (SRF) was calculated for each side. CT-GFR was obtained using CT-SRF and global GFR from modification of diet in renal disease equation. At 12 months after nephrectomy, GFR was estimated from serum creatinine (eGFR). Predonation CT-GFR of preserved kidney was used to predict post-nephrectomy renal function which was compared with post-donation renal function calculated using serum creatinine as well as with DTPA-GFR. Pearson correlation coefficient and scatter diagram were used to assess and test the linear relationship between two continuous variables. The Statistical Package for the Social Sciences, version 23, was used for data analysis. There was a highly significant change in mean DTPA-GFR and mean CT-GFR compared to eGFR values (50.79-64.25, 26.50%, and 50.77-64.25, 26.55%, respectively). Similarly, there was a very good correlation between DTPA-GFR and eGFR (r = 0.968, P <0.001) as well as CT-GFR and eGFR (r = 0.968, P <0.001). CT volumetry-attenuation-based GFR accurately predicts post-donor nephrectomy renal function at 1 year similar to Tc99m-DTPA renal scintigraphy.

SC206 - Are there predictors of renal function after minimally invasive partial nephrectomy? a single centre multivariate analysis

SC206 - Are there predictors of renal function after minimally invasive partial nephrectomy? a single centre multivariate analysis

Renal Function in Children with β-Thalassemia Major Treated with Iron Chelating Agent

BACKGROUND: Thalassemia is a disorder of inherited blood and inticated by the abnormal hemoglobin. Transfusion and iron chelation are part of thalassemia management. Iron chelating agent reduces complications due to the excess iron as a result of repeated transfusions, hence, increasing the survival rate. However, prolonged intake of iron chelating agent may increase the risk of renal function impairment. To date, evaluation of renal function in children with β-thalassemia in Medan has never been reported. The objective of this study was to evaluate renal function and other factors in children with β-thalassemia.METHODS: Fourty-five children with β-thalassemia was recruited in this study. Renal function, represented by estimated glomerular filtration rate (eGFR)and serum ferritin levels were examined. The measurement of eGFR was using Schwartz method.RESULTS: Decreased eGFR observed in some the children (2 patients) with β-thalassemia major treated with iron chelating agent. None of the factors examined had association with serum creatinine level. Children's age and duration of iron chelating agent intake had positive correlation with their eGFR (r=0.506, p&lt;0.001 and r=0.518, p&lt;0.001, respectively). However, serum ferritin levels was not a predictor for renal function impairment.CONCLUSION: Most of children with β-thalassemia major treated with iron chelating agent have normal renal function, nevertheless, decreased renal function is observed in few children. Highlighted, renal function examinations should be performed routinely as iron chelating agent administration is a long-term therapy in children with β-thalassemia major.KEYWORDS: β-thalassemia major, renal function, serum ferritin levels, iron chelating agent

MP57-16 THE ASSOCIATION BETWEEN MODIFIABLE ANESTHETIC PARAMETERS AND RENAL FUNCTION AFTER NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP57)1 Apr 2020MP57-16 THE ASSOCIATION BETWEEN MODIFIABLE ANESTHETIC PARAMETERS AND RENAL FUNCTION AFTER NEPHRECTOMY Roy Mano*, Amy Tin, Andrew Silagy, Samuel Haywood, Chun Huang, Nicole Benfante, Gregory Fischer, Andrew Vickers, Paul Russo, Jonathan Coleman, Patrick McCormick, Joshua Mincer, and A Ari Hakimi Roy Mano*Roy Mano* More articles by this author , Amy TinAmy Tin More articles by this author , Andrew SilagyAndrew Silagy More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Chun HuangChun Huang More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Gregory FischerGregory Fischer More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Paul RussoPaul Russo More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Patrick McCormickPatrick McCormick More articles by this author , Joshua MincerJoshua Mincer More articles by this author , and A Ari HakimiA Ari Hakimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000926.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative anesthetic parameters, primarily intraoperative hypotension, are associated with renal function after surgeries which do not involve the kidney; few studies report their effect in patients undergoing nephrectomy. We evaluated the association between modifiable anesthetic parameters and kidney function after radical and partial nephrectomy. METHODS: We reviewed data from 3,240 consecutive patients who underwent nephrectomy between 2010 – 2018. Intraoperative anesthetic parameters evaluated included duration of hypotension (mean arterial pressure (MAP) <55mmHg), tachycardia (heart rate >100bpm), hypothermia (body temperature <35.5°C) and volatile anesthetic use. MAP at arrival to the post-anesthesia care unit, and total ketorolac dose within 48 hours of surgery were collected. Outcomes included acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) within 1 year after nephrectomy. The associations between the anesthetic parameters and outcomes were evaluated with multivariable logistic regression and longitudinal analyses, respectively, adjusted for known predictors of renal function after nephrectomy. RESULTS: The study cohort included 2111 (65%) males, and the median age was 60 years (IQR 52, 68). Prior to nephrectomy, 677 (21%) patients had stage ≥3 chronic kidney disease (CKD). Over two-thirds (69%) underwent partial nephrectomy. A quarter of the patients had AKI in the immediate postoperative period and 33% had stage ≥3 CKD 12 months after surgery. Most patients were not exposed to intraoperative hypotension [median duration 0 minutes (IQR 0, 2)]. We did not find evidence that intraoperative hypotension was associated with postoperative renal function. Prolonged hypothermia (per 10-min) was consistently associated with an increased rate of AKI (OR 1.02; 95% CI 1.00, 1.04; p=0.024), and a decrease in eGFR (change in eGFR -0.19; 95% CI -0.27, -0.12; p<0.0001). However, while statistically significant, these results have limited clinical significance, aside for a small number of patients exposed to very long hypothermia (Figure 1). CONCLUSIONS: Current practice is aimed at tightly maintaining blood pressure during surgery. Within this setting we did not find an association between intraoperative hypotension and renal function after nephrectomy. Source of Funding: This work was supported by The Sidney Kimmel Center for Prostate and Urologic Cancers. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e867-e868 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roy Mano* More articles by this author Amy Tin More articles by this author Andrew Silagy More articles by this author Samuel Haywood More articles by this author Chun Huang More articles by this author Nicole Benfante More articles by this author Gregory Fischer More articles by this author Andrew Vickers More articles by this author Paul Russo More articles by this author Jonathan Coleman More articles by this author Patrick McCormick More articles by this author Joshua Mincer More articles by this author A Ari Hakimi More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of the prognostic factors of renal function after nephron sparing surgery

Objective To investigate the prognostic factors of renal function after nephron sparing surgery (NSS) in renal tumor patients. Methods The data of 115 patients who underwent NSS in our hospital from December 2016 to December 2018 were retrospectively analyzed. There were 75 males and 40 females, aged (49.50±12.94) years. The body mass index was (24.59±3.59) kg/m2. The maximum diameter of the tumor was (3.66±1.32) cm. The R. E.N.A.L. score was (6.43±1.60). Laparoscopic partial nephrectomy was performed in 61 cases and robot-assisted laparoscopic partial nephrectomy was performed in 54 cases, and all of which were successfully completed. Operative time, WIT and postoperative pathological results were recorded. Blood creatinine value, GFR of affected kidney, GFR of healthy kidney, total GFR, GFR preserving rate (the ratio of postoperative GFR to preoperative GFR), functioning parenchymal volume (FPV) of the affected kidneys, and FPV preserving rate of the affected kidneys (the ratio of postoperative FPV and preoperative FPV) were recorded 6 months after surgery. FPV was measured by the ellipsoid approximation on CT images before and after surgery. Paired sample t test was used to compare GFR and FPV before and after surgery. Spearman rank correlation analysis was used to evaluate the correlation between the study factors and GFR preserving rate of the affected kidneys. Multivariate linear regression models were used to analyze independent predictors of renal function of the affected kidneys. Independent sample t test was used for comparison between group of WIT≤25 min and group of WIT>25 min. Results All of the 115 patients in this study underwent successfully operations, with the median operation time of 135(75-245) min, and WIT(24.57±5.51) min. Postoperative GFR of the affected kidneys(35.50±7.81)ml/(min·1.73 m2) was significantly different from preoperative GFR(P 25 min group had a significantly lower GFR preserving rate of the affected kidneys than WIT≤25 min group [(68.77±10.88)% vs.(79.34±8.88)%, P<0.001]. Conclusions In the case of short WIT (<30 min), the reservation of normal renal tissue is the most important variable prognostic factor of renal function after NSS, and short WIT plays a secondary role. Under the premise of complete tumor resection, normal renal tissue should be reserved as much as possible and WIT should be controlled within 25 min. Key words: Kidney neoplasms; Nephron sparing surgery; Renal function; Warm ischemia

Early trends and predictors of renal function following computed tomography-guided percutaneous cryoablation of a renal mass in patients with and without prior renal impairment.

ObjectiveTo assess trends and predictors of the glomerular filtration rate (GFR) after renal mass cryoablation in patients with and without history of renal impairment.Materials and MethodsThis was a retrospective study of 39 patients who underwent computed tomography-guided percutaneous cryoablation of a renal mass, divided into two groups: those with prior renal impairment (PRI+); and those without prior renal impairment (PRI−). The GFR trend and the chronic kidney disease stage were evaluated at baseline, as well as at 1, 6, and 12 months after cryoablation. Predictors of GFR at 1 and 6 months were modeled with linear regression.ResultsIn both groups, the mean GFR at 1 month and 6 months was significantly lower than at baseline (p < 0.001 and p = 0.01, respectively). Although the GFR was lower across all time points in the PRI+ group (−26.1; p < 0.001), the overall trend was not statistically different from that observed in the PRI− group (p = 0.89). Univariate analysis showed that the decline in GFR at 1 and 6 months correlated with the baseline GFR (0.77 and 0.63; p < 0.001 and p = 0.03, respectively) and with the size of the ablation zone (−7.6 and −12.84, respectively; p = 0.03 for both). However, in the multivariate model, baseline GFR was predictive only of GFR at 1 month (p < 0.001).ConclusionThe trend in GFR decline after cryoablation is similar for patients with and without a history of renal impairment. Baseline GFR predicts the mean GFR in the early post-cryoablation period.

Correlation between cortical renal thickness and estimated glomerular filtration rate in diabetic nephropathy patients

Background and Objectives: Conventionally urine creatinine test and renal ultrasound are used in clinical practice for staging and progression of diabetic nephropathy. The objectives of this study were (1) to determine the correlation between cortical renal thickness and eGFR (estimated glomerular filtration rate) in diabetic nephropathy, and (2) to further assess if the cortical renal thickness is a better predictor of eGFR than the linear bipolar length in diabetic nephropathy. Materials and Methods: A total of 163 patients were recruited between April 2017 and March 2018 (86 men and 77 women) who had diabetic nephropathy with eGFR <90mL/min/1.73 m2 according to Cockcroft–Gault formulation. Results: The mean age (mean ± standard deviation [SD]) of the patients was 59.5 ± 7.2 years with range 39 –78 years and the median age was 59 years. The mean level of creatinine (mean ± SD) of the patients was 1.4 ± 0.4 mg/dL with range 0.6–3.2 mg/dL and the median was 1.4 mg/dL. Mean eGFR (in mL/min/1.73 m2) being 49.8 ± 13.4 (range 41.2–62.5). Cortical renal thickness right upper part, right middle part, left upper part, and left middle part (in mm) were found to be 5.5 ± 1.04, 5.6 ± 1.05, 5.5 ± 1, and 5.6 ± 1.02, respectively. Mean values of renal length of right- and left-sided kidney were 9.2 ± 0.4 and 9.5 ± 0.4, respectively. Pearson’s coefficient of correlation showed a moderately significant correlation between eGFR and cortical renal thickness in diabetic nephropathy patients. Correlation coefficient of the cortical renal thicknesses correlated better with eGFR than cortical renal length. Summary and Conclusion: This cross-sectional study in diabetic nephropathy patients showed a positive correlation between eGFR and cortical renal thickness. Cortical renal thickness was found to be a better predictor of renal function than bipolar renal length.

Stereotactic Radiotherapy as a Treatment Option for Renal Tumors in the Solitary Kidney: A Multicenter Analysis from the IROCK.

Stereotactic ablative radiotherapy is an emerging treatment for renal cell carcinoma. Our study objective was to evaluate this therapy in patients with a solitary kidney, focusing on oncologic and renal function outcomes. We pooled individual patient data from 9 IROCK (International Radiosurgery Oncology Consortium for Kidney) institutions in Germany, Australia, the United States of America, Canada and Japan. Median followup was 2.6 years. Baseline characteristics and outcomes were compared between the solitary and bilateral kidney cohorts. Predictors of renal function after stereotactic ablative radiotherapy were assessed by logistic regression modeling. A total of 81 patients with a solitary kidney underwent stereotactic ablative radiotherapy. Mean age was 67.3 years and 97.5% of patients had good performance status, including ECOG (Eastern Cooperative Oncology Group) 0-1 or KPS (Karnofsky Performance Status) 70% or greater. Median tumor diameter was 3.7 cm (IQR 2.5-4.3) and 37% of tumors were 4 cm or greater. The 138 patients in the bilateral cohort harbored larger tumors and were older (p <0.001) with a lower baseline estimated glomerular filtration rate (p = 0.024). After stereotactic ablative radiotherapy in the solitary kidney cohort the mean ± SD estimated glomerular filtration rate decrease was -5.8 ± 10.8 ml per minute (-9%). No patient with a solitary kidney required dialysis. After stereotactic ablative radiotherapy a tumor size of 4 cm or greater was associated with an estimated glomerular filtration rate decrease of 15 ml per minute or greater (OR 4.2, p = 0.029). At 2 years the rates of local control, and progression-free, cancer specific and overall survival in the solitary cohort were 98.0%, 77.5%, 98.2% and 81.5%, respectively. There was no significant difference in renal function or oncologic outcomes between the cohorts (p >0.05). In this analysis of the IROCK database stereotactic ablative radiotherapy in patients with a solitary kidney had an acceptable impact on renal function and achieved excellent oncologic outcomes, similar to those in patients with bilateral kidneys. Thus, stereotactic ablative radiotherapy represents a viable treatment option in patients with renal cell carcinoma in a solitary kidney.

Best Noninvasive Predictor of Renal Function in Assessing Adult Sickle Nephropathy

Best Noninvasive Predictor of Renal Function in Assessing Adult Sickle Nephropathy

Impact of autologous stem cell transplant in myeloma patients on renal function and overall survival.

e19535 Background: Renal impairment has been negatively associated with progression free survival and overall survival in patients diagnosed with multiple myeloma (MM). Autologous stem cell transplant (ASCT) has become a standard of care for treatment in MM. Most previous studies have assessed the safety of ASCT and the improvement in renal function in patients with MM. However, a critical question about renal function over time, and its impact on survival after ASCT has rarely been addressed. In our study we sought to understand how renal function was impacted over time, the predictors of renal function, and overall survival after ASCT. Methods: We performed a retrospective review of all MM patients who underwent ASCT at MDACC from January1, 2008 through December 31, 2013. A total of 885 none dialysis patients who received Melphalan alone as the conditioning regimen were identified. We collected demographic information, ISS stage, and disease status at time of transplant and at last follow up. Creatinine, GFR (calculated using CKD Epi equation), calcium, and LDH were also collected at day 0, 100, 180, &amp; 365. Given the longitudinal nature of the data, linear mixed effect models were used to study the change of GFR over time. A joint model approach for longitudinal and survival data was used to assess association between overall survival and GFR with patient’s age at transplant, ISS, disease status, disease risk category and response to treatment prior to transplant included in the linear mixed effect models and hazard models. As sensitivity analyses, landmark analyses were conducted with day 0, 100, 180, and 365 days post-transplant as landmark time points. Results: Patients’ GFR at post-transplant time points were significantly higher (p ≤ 0.025) compared to the day of ASCT. A higher ISS stage at diagnosis was significantly associated with a lower GFR (p &lt; .0001) at all stages of chronic kidney disease. Specifically, compared to the patients with ISS stage I, those with ISS stage II or higher had lower GFR across all time points (p ≤ .0003). GFR value was not significantly associated with OS in any of the analyses described above. In contrast, disease status, ISS stage, response to induction prior to SCT were all associated with shorter OS. Conclusions: The study demonstrates in a large cohort and in a longitudinal manner that MM patients who underwent ASCT did not have further decline in GFR over time. In addition, GFR was strongly associated with ISS stage. As far as OS, MM-related factors significantly impacted the survival while GFR did not.

PT199 - Evaluation of renal volume and adipose tissue distribution as predictors of renal function after radical nephrectomy

PT199 - Evaluation of renal volume and adipose tissue distribution as predictors of renal function after radical nephrectomy

1048 - CT measurement of intraparenchymal tumor volume as predictor of renal function after robotic partial nephrectomy

1048 - CT measurement of intraparenchymal tumor volume as predictor of renal function after robotic partial nephrectomy