Residual renal function after partial or radical nephrectomy for renal cell carcinoma

Abstract

Renal cell carcinoma (RCC) is often detected incidentally and early. Currently, open partial nephrectomy and laparoscopic total nephrectomy form competing technologies. The former is invasive, but nephron-sparing; the other is considered less invasive but with more loss of renal mass. Traditionally, emphasis has been placed on oncologic outcomes. However, a patient with an excellent oncologic outcome may suffer from morbidity and mortality related to renal failure. Animal models with hypertension and diabetic renal disease indicate accelerated progression of pre-existing disease after nephrectomy. Patients with RCC are older and they have a high prevalence of diabetes and hypertension. The progression of renal failure may also be accelerated after a nephrectomy. Our analysis of the available literature indicates that renal outcomes in RCC patients after surgery are relatively poorly defined. A strategy to systematically evaluate the renal function of patients with RCC, with joint discussion between the nephrologist and the oncologic team, is strongly advocated.Can Urol Assoc J 2010;4(5):337-343 Résumé L'hypernéphrome est souvent décelé fortuitement et au stade pré-coce. Actuellement, la néphrectomie partielle par voie ouverte et la néphrectomie totale par laparoscopie sont des technologies concurrentes. Tandis que la première est plus invasive, mais permet l'épargne des néphrons, la seconde est moins invasive mais entraîne une perte plus importante de masse rénale. Par le passé, on a mis l'emphase sur les résultats d'un point de vue oncologique. Cependant, un patient pour qui la chirurgie donne d'excellents résul-tats en matière d'élimination de la tumeur pourrait présenter une morbidité et une mortalité en lien avec une insuffisance rénale. Des modèles animaux de néphropathie avec hypertension et diabète indiquent une évolution accélérée des maladies préexistantes après la néphrectomie. Les patients présentant un hypernéphrome sont plus âgés; la prévalence du diabète et de l'hypertension est élevée. L'évolution de l'insuffisance rénale peut aussi être accélérée après la néphrectomie. Notre analyse des articles publiés montre que les résultats sur le plan de la fonction rénale après une chirurgie pour traiter un hypernéphrome sont relativement mal définis. Une straté-gie fondée sur une évaluation systématique de la fonction rénale des patients atteints d'hypernéphrome, avec discussion entre le néphro-logue et l'équipe de soins oncologiques, est fortement encouragée.

Egyptian Pyramid Model Housing Enhancing the Compensatory Renal Growth in Nephrectomized Rats

“…Activation of the TGF system will begin afferent arteriolar vasoconstriction [59]. In accord with Chapman et al [3], the present study showed increase in GFR in the remaining renal tissue following the nephrectomy as consequence of TGF system activation that allowing higher early distal flow rates.…”

“…The renal clearance of endogenous creatinine is widely used to assess GFR and renal function in animal investigations [52]. In conjunction with the reports of Bohlouli et al [53] and Chapman et al [3], the present study revealed significant increase in creatinine clearance following unilateral nephrectomy in rats. Mueller & Luyckx [54] reported increase in GFR by 60%-70% following uni-nephrectomy in the remaining kidney.…”

“…Following nephrectomy, plasma volume will expand because of the decrease in renal excretory function [3]. Consequently, angiotensin II formation is diminished, that will attenuate afferent arteriole tone allowing an increase in glomerular pressure and filtration [3].…”

“…CKD defined as the presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function that quantified by glomerular filtration rate (GFR) measurement [2].The patients with reduced renal mass found evidence for lower glomerular filtration rate [3]. The impaired GFR in chronic kidney disease and the increased filtration load on the remnant glomeruli led to the increased excretion of ions and levels of creatinine in plasma [4,5].…”

A Review on Treatment of Renal Anemia in Patients With Chronic Kidney Disease and Hemodialysis

“…[12] The anemia of CKD increases morbidity and mortality from cardiovascular complications which may lead to further deterioration of renal function. [13] Red cell production due to the Erythropoietin deficiency is too low in CRF and causes development of anemia in this situation. Anemia is also seen in patients with acute renal failure but the exact relationship between them remained unclear.…”