Chronic Kidney Disease Due to Surgical Removal of Nephrons: Relative Rates of Progression and Survival

Demirjian, Sevag; Lane, Brian R.; Derweesh, Ithaar; Takagi, Toshio; Fergany, Amr; Campbell, Steven C.

doi:10.1016/j.juro.2014.04.016

Cited by 115 publications

(71 citation statements)

References 24 publications

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“…6 CKD-S has been proposed to be a separate entity that impacts less on survival and long-term function in patients without CKD-M, 6 but compounds the impact in patients with CKD-M already (CKD-M/S). 7 These findings suggest that the definition and classification of CKD based solely on GFR may not accurately reflect the extent of kidney disease in patients developing CKD-S. As CKD-S results in reduced complement of nephrons, kidney volume would theoretically be an ideal anatomical representation of kidney reserve. It could better reflect the tolerability of a patient to developing CKD after the surgical insult of RN.…”

Section: Introductionmentioning

confidence: 96%

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Tay

Tai

et al. 2015

Journal of Endourology

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Objectives: Surgically induced chronic kidney disease (CKD) has been found to have less impact on survival as well as function when compared to medical causes for CKD. The aim of this study is to evaluate whether preoperative remaining kidney volume correlates with renal function after nephrectomy, which represents an individual's renal reserve before surgically induced CKD. Methods: A retrospective review of 75 consecutive patients (29.3% females) who underwent radical nephrectomy (RN) (2000-2010) was performed. Normal side kidney parenchyma, excluding renal vessels and central sinus fat, was manually outlined in each transverse slice of CT image and multiplied by slice thickness to calculate volume. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. CKD is defined as eGFR <60 mL/min/1.73 m 2 .Results: Mean preoperative normal kidney parenchymal volume (mean age 55 [SD 13] years) is 150.7 (SD 36.4) mL. Over median follow-up of 36 months postsurgery, progression to CKD occurred in 42.6% (n = 32) of patients. On multivariable analysis, preoperative eGFR and preoperative renal volume <144 mL are independent predictors for postoperative CKD. On Kaplan-Meier analysis, median time to reach CKD postnephrectomy is 12.7 (range 0.03-43.66) months for renal volume <144 mL but not achieved if renal volume is >144 mL. Conclusions: Normal kidney parenchymal volume and preoperative eGFR are independent predictive factors for postoperative CKD after RN and may represent renal reserve for both surgically and medically induced CKD, respectively. Preoperative remaining kidney volume may be an adjunct representation of renal reserve postsurgery and predict later renal function decline due to perioperative loss of nephrons.

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Section: Introductionmentioning

confidence: 96%

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Tay

Tai

et al. 2015

Journal of Endourology

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“…Our research in the area of CKD primarily due to surgical removal of nephrons (CKD-S) suggests that this disease entity may be associated with a lower risk of CKD progression and improved overall survival when compared to CKD with medical etiology (CKD-M) [6,9]. Limitations of our prior work included a lack of data regarding cause of death and only intermediateterm follow-up.…”

Section: Introductionmentioning

confidence: 99%

Survival and Functional Stability in Chronic Kidney Disease Due to Surgical Removal of Nephrons: Importance of the New Baseline Glomerular Filtration Rate

et al. 2015

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“…The decline of eGFR in all patients with a CVE was 2.6% per year. Patients without CVE in contrast lost 1.3% of eGFR per year and a decline of 0.7% per year are described in the literature for patients after RN [19]. In our study, the cause for CVEs was the drop of eGFR over the years.…”

Section: Discussionmentioning

confidence: 53%

“…The decay of eGFR has been described as 13.98% in a 1-year follow-up [17] and 25.5% after RN in a 4.9-year follow-up [18] or 0.7% of eGFR per year [19] without regarding the incidence of CVEs, but no data are available for patients after DN. To our knowledge, this study is the first to compare patients after DN and RN for the decline of eGFR and the incidence of CVEs.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up

Nestler

Levien²,

Neisius³

et al. 2016

Urol Int

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Introduction: The study aimed to compare the incidence of cardiovascular events (CVEs) after donor nephrectomy (DN) and radical tumor nephrectomy (RN), according to an estimated glomerular filtration rate (eGFR), were evaluated over time. Materials and Methods: Follow-up was collected for DN who underwent surgery from 1998 to 2007 for CVE and renal function. All DN were matched for age to patients treated by RN or adenoma enucleation (control group), who were eligible for DN. eGFR was estimated using the Cockgroft-Gould formula. Patients with preoperative comorbidities were excluded. Results: Thirty DN (median age 48.9 years) were included with a median follow-up of 138.5 months (interquartile range 119-159). No significant differences in patients' characteristics were found preoperatively (p > 0.5). Four out of 30 DN developed a CVE (3 myocardial infarctions (MI), 1 stroke), 2 of 30 patients in the control group (both MI) and 8 of 30 RN patients (6 MI, 2 strokes, p > 0.05). Arterial hypertension developed in 14 DN (46.7%), in 12 (40%) after RN and in 15 controls. The CVE occurred after a median time of 68 months (5-231) and were related to a drop of ∼30% in the eGFR irrespective of the group. Conclusion: Decline of renal function after nephrectomy is the main risk factor for CVE. Close monitoring of renal function and new onset hypertension is warranted.

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Chronic Kidney Disease Due to Surgical Removal of Nephrons: Relative Rates of Progression and Survival

Cited by 115 publications

References 24 publications

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

Survival and Functional Stability in Chronic Kidney Disease Due to Surgical Removal of Nephrons: Importance of the New Baseline Glomerular Filtration Rate

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up

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