Natural history of chronic renal insufficiency after partial and radical nephrectomy Journal Article

Authors: McKiernan, J.; Simmons, R.; Katz, J.; Russo, P.
Article Title: Natural history of chronic renal insufficiency after partial and radical nephrectomy
Abstract: Objectives. To compare the incidence of newly developed chronic renal insufficiency after partial nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended to preserve renal function; however, studies of transplant donors suggest normal renal function is also maintained after unilateral nephrectomy. Methods. We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm or less in the presence of a normal contralateral kidney from 1989 to 2000. Creatinine failure was defined as a serum creatinine value greater than 2.0 mg/dL. Risk factors for renal insufficiency, including diabetes, hypertension, American Society of Anesthesiologists score, age, preoperative creatinine, and history of smoking tobacco, were compared between the two groups. We compared the two groups using the chi-square and Mann-Whitney U tests and the creatinine failure rates using the Kaplan-Meier method. Results. One hundred seventy-three patients met the criteria for analysis after RN and 117 did so after PN (median follow-up 25 months). The 5-year freedom from recurrence rate was 96.4% and 98.6% for PN and RN, respectively (P >0.05). The mean preoperative serum creatinine was 1.0 mg/dL (range 0.4 to 1.4) and 0.98 (range 0.6 to 1.5) for RN and PN, respectively (P = 0.4, not significant). The incidence of risk factors for renal insufficiency did not differ between the two groups. The mean postoperative serum creatinine in the RN and PN groups was 1.5 mg/dL (range 0.8 to 3.8) and 1.0 mg/dL (range 0.5 to 1.9), respectively (P <0.001). The chance of creatinine failure over time was significantly greater in the RN group (P = 0.008). Conclusions. When controlled for preoperative risk factors for renal insufficiency, patients undergoing RN are at a greater risk of chronic renal insufficiency than a similar cohort of patients undergoing PN. © 2002, Elsevier Science Inc.
Keywords: adult; controlled study; human tissue; aged; aged, 80 and over; disease-free survival; middle aged; retrospective studies; major clinical study; hypertension; recurrence risk; prospective studies; biological markers; incidence; cohort analysis; risk factors; smoking; creatinine; creatinine blood level; retrospective study; risk factor; kidney neoplasms; nephrectomy; kidney tumor; carcinoma, renal cell; kidney function; diabetes mellitus; kaplan meier method; regression analysis; chronic kidney failure; chi square distribution; elective surgery; kidney failure, chronic; tobacco smoke; kidney donor; humans; human; male; priority journal; article
Journal Title: Urology
Volume: 59
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2002-06-01
Start Page: 816
End Page: 820
Language: English
DOI: 10.1016/s0090-4295(02)01501-7
PUBMED: 12031359
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
Citation Impact
MSK Authors
  1. Paul Russo
    543 Russo
  2. Jared   Katz
    13 Katz