BERKELEY, CA (UroToday.com) - This is an extremely important report of the importance of preserving as much normal functioning renal tissue as possible when treating patients with renal tumor disease.

These researchers at UT Southwestern clearly demonstrate that in all patients presenting with renal tumors almost a third will have pre-existing compromise of their renal function to stage 3 chronic kidney disease (CKD) as defined by a GFR < 60 ml/min/1.73 m². The 242 patients in this study were almost equally divided into treatment groups including, radiofrequency ablation (RFA), partial nephrectomy, (PN) or radical nephrectomy (RN) and followed over 5 years. Following intervention new onset of stage 3 CKD was significantly more prevalent in the RN group than the other two treatment groups. The characteristics of each group were similar, except there was a significant difference in incidence of malignancy among the two less invasive approaches to management. Benign lesions were noted in 37% of RFA, 20% of PN and 12% of RN patients. (p-value = 0.001). The morbidity associated with even a modest decline in GFR can be very significant and may effect the patient long after the initial renal insult. In this study four of the 242 patients required dialysis post-operatively, including 2 RN patients and 1 patient each in the PN and RFA groups. The percentage of patients who did not suffer a reduction of GFR below the stage 3 CDK was 95% for RF, 71% for PN and 40% for RN (p<0.001). This article highlights the importance of adequately treating the patient’s renal tumor, while maintaining maximum renal reserve for future medical challenges.

SM Lucas, JM Stern, M Adibi, IS Zeltser, JA Cadeddu, GV Raj

J. Urol. 179(1):75-80, January 2008
doi:10.1016/j.juro.2007.08.156

PubMed Abstract
PMID:17997440

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Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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