Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)

Abstract

Purpose To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)—1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR − baseline eGFR; Δ2 = 6 months eGFR − POD-1 eGFR; Δ3 = 12 months eGFR − 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. Results A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p < 0.001) during follow-up. Conclusion Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.

Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes

“…These findings were partially confirmed later by a multicenter study conducted by the RaNeO research consortium [61], where the presence of hydronephrosis was associated with lower renal function reduction. A possible explanation of this phenomenon could rely on the fact that established contralateral compensatory kidney hypertrophy of the ipsilateral urinary tract facilitates the compensatory role of the remnant solitary kidney.…”

“…On the other hand, recent evidence suggests that preoperative eGFR ≤60 might have a negative impact on renal function recovery [ 62 , 63 ]. Moreover, a detrimental effect of postoperative acute kidney injury on eGFR can still be recognized at 6 and 12 months after surgery [ 61 ].…”

Changes in Renal Function After Nephroureterectomy for Upper Tract Urothelial Cancer in Elderly Patients

“…In all patients, the median eGFR was 14.7 mL/min/1.73 m 2 lower from the preoperative period to the one-month postoperative period, and 23% of patients had an eGFR ≥ 50 at one month postoperatively. Previous studies demonstrated that the eGFR after RNU decreased at approximately 11.2-14.0 mL/min/1.73 m 2 compared to that preoperatively [ 5 , 8 - 10 ]. However, these reports differ in the timing of postoperative renal function evaluation, often after three months postoperatively.…”

“…Moreover, Amirian et al [ 14 ] reported that in the ureter, locally advanced tumors theoretically penetrate the muscularis propria, potentially diminishing peristaltic activity, and thus causing obstruction, with HN being the result. In another study, the renal function of patients with UTUC with HN decreased only 5.5 mL/min/1.73 m 2 between the pre- and postoperative periods [ 8 ]. Our study showed that the eGFR of elderly patients with HN declined only to 8.3 mL/min/1.73 m 2 between the preoperative period and the one-month postoperative period.…”

Case report: Sarcomatoid urothelial carcinoma of the renal pelvis masquerading as a renal abscess

“…Furthermore, 50% of patients are not eligible for platinum-based chemotherapy due to postoperative renal failure. Therefore, patients are at high risk of postoperatively reduced renal function and it is recommended that neoadjuvant chemotherapy be considered ( 34 ). At present, the relative efficacy of adjuvant radiotherapy in SUC cases remains to be established.…”