Proteinuria is a Predictor of Renal Functional Decline in Patients with Kidney Cancer

O'Donnell, Kelly; Tourojman, Mouafak; Tobert, Conrad M.; Kirmiz, Samer; Riedinger, Christopher B.; Demirjian, Sevag; Lane, Brian R.

doi:10.1016/j.juro.2016.03.134

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…The present study was limited by its retrospective design and the inherently associated selection bias. Our database did not include the presence or absence of proteinuria, which is shown to predict CKD after PN . We also did not assess the duration and severity of HTN or DM due to the lack of such data, which is a significant contributor to kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…Our database did not include the presence or absence of proteinuria, which is shown to predict CKD after PN. 24 We also did not assess the duration and severity of HTN or DM due to the lack of such data, which is a significant contributor to kidney function. Additionally, the Modification of Diet in Renal Disease formula was originally validated for patients with CKD, and does not include adjustment for BMI.…”

Section: Discussionmentioning

confidence: 99%

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Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

et al. 2018

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Objective To analyze the association of hypertension and/or diabetes mellitus on renal function after partial nephrectomy in patients with normal baseline kidney function. Methods We identified 453 patients with baseline estimated glomerular filtration rate ≥60 that underwent robotic partial nephrectomy for a cT1 renal mass from 2008 to 2014 using a multi‐institutional database. The association between estimated glomerular filtration rate and time (pre‐partial nephrectomy to 24 months post‐partial nephrectomy) was compared between 269 (59.4%) patients with preoperative hypertension and/or diabetes mellitus and 184 (40.6%) patients with neither hypertension nor diabetes mellitus using a multivariable model adjusting for confounders. Results The estimated glomerular filtration rate significantly decreased over time for both groups compared with baseline (average units/month: 1.8974 hypertension/diabetes mellitus, 1.2163 no hypertension/diabetes mellitus; P < 0.0001), and the estimated glomerular filtration rate decrease per month reduced over time (P < 0.0001). The estimated glomerular filtration rate began to increase at approximately 12 months for the hypertension/diabetes mellitus group, and at approximately 18 months for the no hypertension/diabetes mellitus group. Although a greater initial decline in the estimated glomerular filtration rate after partial nephrectomy was observed for the hypertension/diabetes mellitus group (0.68 units/month), this was not statistically significant (P = 0.0842); and while the rate of recovery from this decline was faster for the hypertension/diabetes mellitus group, this also was not statistically significant (P = 0.0653). The predicted estimated glomerular filtration rate was similar (83 mL/min/1.73 m2) for both groups 24 months after partial nephrectomy. Conclusions There seems to be no significant association between hypertension, diabetes mellitus and renal functional outcome after partial nephrectomy in patients with normal baseline glomerular filtration rate. Renal function declines after partial nephrectomy, but then it recovers, irrespective of the presence of hypertension or diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

et al. 2018

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“…Severe proteinuria was not only found to be an independent risk factor for stroke, but was also an independent predictive factor for a poor prognosis of stroke [26–28]. Patients with KC may have increased urine protein levels [29], but the relationship between proteinuria and cancer-related stroke has been unclear. In the present study, compared to KC patients, KCS patients had higher proteinuria levels, and multivariate logistic regression analysis revealed that the increased urine protein levels may independently increase the risk of stroke in KC patients.…”

Section: Discussionmentioning

confidence: 99%

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

et al. 2017

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BackgroundStroke risk and stroke recurrence are increased in cancer patients, but the pathogenesis and biomarkers of kidney cancer-related stroke (KCS) are generally unclear. The aim of the present research was to investigate the pathogenesis and plasma biomarkers of kidney cancer-related stroke.Material/MethodsA retrospective review was conducted on acute stroke patients with kidney cancer (KC) who were admitted to the hospital between January 2006 and December 2015. A total of 106 patients with KCS (active KC patients with acute stroke but without conventional vascular risks) were identified. In addition, 106 age- and sex-matched patients with KC alone were recruited.ResultsKCS patients had higher plasma D-dimer, cancer antigen (CA) 125, and CEA levels and greater proteinuria levels than did KC patients. Multiple logistic regression analysis showed that the risk of stroke in patients with KC increased independently by 0.8% (odds ratio [OR] 1.008; 95% confidence interval [CI] 1.002, 1.013; p=0.004) with a 1 ng/mL increase in D-dimer levels, by 1.2% (OR 1.012; 95% CI 1.007, 1.018; p=0.000) with a 1 U/mL increase in CA125, by 2.5% (OR 1.025; 95% CI 1.012, 1.038; p=0.000) with a 1 U/mL increase in CEA by 1.4% (OR 1.014; 95% CI 1.005, 1.024; p=0.004) with a 1 mg increase in urine protein in 24 hours.ConclusionsElevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels might lead to hypercoagulability and then KCS; however, they may also be biomarkers of KCS.

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“…The present study found that higher preoperative eGFR and lower preoperative albuminuria were associated with a higher risk of AKI and postoperative SCr rise. Whilst these observations seem somewhat counterintuitive, given that higher eGFR and lower albuminuria predict a lower long-term risk of CKD ( 9 , 10 ), there is support in the literature for their validity. In a single-centre retrospective cohort study of 519 patients undergoing RN in Korea, Cho et al identified that higher baseline eGFR independently associated with AKI within seven postoperative days (OR: 1.49, 95% CI: 1.27, 1.73) ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction–Tumour Nephrectomy Database study

Ellis

Vecchio

et al. 2017

Transl. Androl. Urol.

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BackgroundTo identify factors associated with acutely elevated serum creatinine (SCr) within 7 days of radical tumour nephrectomy.MethodsThe study population consisted of 130 consecutive patients managed for renal tumours. The primary outcome was acute kidney injury (AKI) (defined as SCr increase ≥50% above baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase, assessed using multivariable linear regression analysis.ResultsFollowing nephrectomy, the mean percentage increase in SCr in the first week was 55%±29%, and 77 (59%) patients experienced AKI. Independent predictors of AKI post-nephrectomy were male gender [adjusted odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.01, 6.93], urine albumin-creatinine ratio (OR: 0.66; 95% CI: 0.47, 0.91), preoperative estimated glomerular filtration rate (eGFR) (OR: 1.03; 95% CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95% CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (RCC) (OR: 2.93; 95% CI: 1.04, 8.29). Independent predictors of a SCr increase were male gender (β: 12.0; 95% CI: 2.69, 21.3), urine albumin-creatinine ratio (β: –3.36; 95% CI: –6.55, –0.16), preoperative eGFR (β: 0.38; 95% CI: 0.10, 0.66), laparoscopic nephrectomy (β: 12.7; 95% CI: 1.05, 24.3) and obesity (β: 9.94, 95% CI: 0.61, 19.3).ConclusionsMale gender, albuminuria, eGFR and laparoscopic nephrectomy independently associated with acutely elevated serum creatinine following radical tumour nephrectomy.

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Proteinuria is a Predictor of Renal Functional Decline in Patients with Kidney Cancer

Cited by 20 publications

References 23 publications

Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction–Tumour Nephrectomy Database study

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