To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for renal function impairment.
Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1. 73 m2 and single renal tumor cT1, treated in our center between 2005 and 2018.
A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated with RN and 216 (58.1%) with PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age >60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR <60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR <45 mL/min/1.73 m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age >70 years (Falta HR, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR <60 mL/min/1.73 m2. The independent predictors for GFR <45 mL/min/1.73 m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001).
RN is a short- and long-term risk factor for CKD although with a low probability of severe CKD or ESRD in patients with preoperative GFR >60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.
Actas urologicas espanolas. 2022 Feb 22 [Epub ahead of print]
A Luis Cardo, F Herranz Amo, M Rodríguez Cabero, J Hernández Cavieres, D Subirá Ríos, M Moralejo Gárate, J Aragón Chamizo, G Barbas Bernardos, D Ramirez Martín, C Hernández Fernández
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: ., Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Servicio de Urología, Clínica Universidad de Navarra, Madrid, Spain., Servicio de Urología, Hospital Universitario Infanta Elena, Madrid, Spain.