You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2010519 IDENTIFICATION OF NEPHROMETRIC VARIABLES PREDICTIVE OF RENAL IMPAIRMENT FOLLOWING PARTIAL NEPHRECTOMY Eugene Cha, Bryan Jeun, Casey Ng, Michael Herman, James Wysock, James DiPietro, Danielle Shehorn, George Shih, Gerald Wang, and Douglas Scherr Eugene ChaEugene Cha More articles by this author , Bryan JeunBryan Jeun More articles by this author , Casey NgCasey Ng More articles by this author , Michael HermanMichael Herman More articles by this author , James WysockJames Wysock More articles by this author , James DiPietroJames DiPietro More articles by this author , Danielle ShehornDanielle Shehorn More articles by this author , George ShihGeorge Shih More articles by this author , Gerald WangGerald Wang More articles by this author , and Douglas ScherrDouglas Scherr More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.595AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We used objective nephrometric criteria on preoperative CT scans to identify variables associated with postoperative renal impairment following partial nephrectomy for renal cortical tumors. METHODS We investigated all patients who underwent a partial nephrectomy for renal cortical tumors at our institution from years 2006 to the present. Of 187 patients during that time span, 58 patients had preoperative CT scans available for evaluation. We calculated the preoperative and postoperative glomerular filtration rates (GFR) as determined by the 4 variable MDRD equation. Renal impairment was defined as a 20% or greater reduction from the preoperative GFR after partial nephrectomy. We subsequently examined 11 distinct criteria on preoperative CT scans to attempt to predict the degree of postoperative renal impairment. Some of these criteria include tumor volume as determined by an ellipsoid formula, endophytic or exophytic distance of tumor relative to renal parenchyma, tumor proximity to collecting system and to renal vessels, tumor laterality, and interlobar location. We also analyzed renal artery clamp times and surgical technique with respect to changes in GFR as well as common risk factors including smoking history, hypertension, diabetes mellitus, or previous history of renal insufficiency. RESULTS Of the 58 patients in our cohort, 16 met our criteria for renal impairment (27.1%). Tumor diameter and endophytic distance were significantly associated with postoperative renal impairment > 20% (p=0.03 and 0.04, respectively). Renal impairment was also associated with interlobar location and tumor volume, though not statistically significant (p=0.08 and p=0.09, respectively). With regard to known risk factors for renal insufficiency, we found no correlation between postoperative renal impairment and history of diabetes, hypertension, smoking and preoperative renal insufficiency. When subdivided by open versus laparoscopic approaches, the cohorts appeared to be well matched in terms of tumor volume (57.2 vs. 27.1 mL, p= 0.35), renal artery clamp time (31.1 vs 34.8 min, p=0.86) and percent reduction in GFR (35.7 vs 32.5, p =0.85). CONCLUSIONS Using an objective nephrometric system based on preoperative CT criteria, tumor diameter and endophytic distance were associated with postoperative renal impairment > 20% after partial nephrectomy. The inclusion of these indices in radiology reports may assist the urologist in the expectant management of renal function during the postoperative period. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e205 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Cha More articles by this author Bryan Jeun More articles by this author Casey Ng More articles by this author Michael Herman More articles by this author James Wysock More articles by this author James DiPietro More articles by this author Danielle Shehorn More articles by this author George Shih More articles by this author Gerald Wang More articles by this author Douglas Scherr More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...