Natural history of chronic renal insufficiency after partial and radical nephrectomy

McKiernan, James M.; Simmons, Rachel; Katz, Jared; Russo, Paul

doi:10.1016/s0090-4295(02)01501-7

Cited by 485 publications

(239 citation statements)

References 23 publications

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“…However, as these lost nephrons cannot be restored, the individual is more likely to develop renal insufficiency/failure at the long term. This may explain the decrease in renal function observed after some years in patients submitted to renal ischemia for partial nephrectomy 4,19,20 .…”

Section: Resultsmentioning

confidence: 99%

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

et al. 2016

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PURPOSE:To evaluate the glomerular loss after arteriovenous or arterial warm ischemia in a swine model. METHODS:Twenty four pigs were divided into Group Sham (submitted to all surgical steps except the renal ischemia), Group AV (submitted to 30 minutes of warm ischemia by arteriovenous clamping of left kidney vessels), and Group A (submitted to 30 minutes of ischemia by arterial clamping). Right kidneys were used as controls. Weigh, volume, cortical volume, glomerular volumetric density (Vv[Glom]), volume-weighted glomerular volume (VWGV), and the total number of glomeruli were measured for each organ. RESULTS:Group AV showed a 24.5% reduction in its left kidney Vv[Glom] and a 25.4% reduction in the VWGV, when compared to the right kidney. Reductions were also observed when compared to kidneys of sham group. There was a reduction of 19.2% in the total number of glomeruli in AV kidneys. No difference was observed in any parameters analyzed on the left kidneys from group A. CONCLUSIONS:Renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage, but arteriovenous clamping caused significant glomerular loss in a swine model. Clamping only the renal artery should be considered to minimize renal injury after partial nephrectomies.

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Section: Resultsmentioning

confidence: 99%

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

et al. 2016

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“…It has been demonstrated that both open and laparoscopic partial nephrectomy produce superior functional outcomes and oncologic outcomes that are at least equivalent to the outcomes produced after radical nephrectomy for selected tumors. 16,[19][20][21][22] Percutaneous tumor ablation and active surveillance are considered for patients who may be poor surgical candidates. Although it is not quite as effective as partial nephrectomy, approximately 80% of patients are disease-free after thermal ablation, and this remains a valid nephron-sparing intervention for this age group.…”

Section: Discussionmentioning

confidence: 99%

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Lane

Abouassaly

Gao

et al. 2010

Cancer

235

138

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BACKGROUND: Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors 7 cm detected at age 75 years to investigate whether surgical intervention improved survival compared with active surveillance. METHODS: Clinical T1 renal tumors were managed with surveillance (20%), nephron-sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables. RESULTS: The median follow-up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan-Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron-sparing intervention (P ¼ .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P ¼ .0004) and comorbidity (P < .0001) but not management type (P ¼ .3). Preoperative renal function (P ¼ .006) and comorbidity (P ¼ .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function. CONCLUSIONS: In patients aged 75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010;116:3119-26.

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“…2 Many other retrospective studies assessing different populations and utilizing various measures of renal function validated these results. 67,[77][78][79] Other studies have demonstrated the association between worsening renal function and increased risk of cardiovascular events and death. Go et al laid the foundation for this work in their study analyzing over 1,000,000 patients from the Kaiser Permanente system in Northern California.…”

Section: Benefits Of Nephron-sparingmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Natural history of chronic renal insufficiency after partial and radical nephrectomy

Cited by 485 publications

References 23 publications

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

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