Nephrectomy for Tumors May Result in Poor Renal Outcomes
Patients who undergo nephrectomy for renal tumors are at increased risk for adverse renal outcomes, a recent study found.
The study, led by Scott Klarenbach, MD, MSc, of the University of Alberta in Edmonton, used data from the Alberta Kidney Disease Network to determine the risk factors and predictors for the development of adverse renal outcomes in patients undergoing partial or complete nephrectomy.
Dr. Klarenbach's group identified 1,151 patients who had undergone nephrectomy for renal masses and assessed postsurgical outcomes of end-stage renal disease (ESRD), acute dialysis, chronic kidney disease (CKD), and rapidly progressive CKD.
The results revealed that adverse renal outcomes are common in patients undergoing nephrectomy for renal tumors. Specifically, over an average of 32 months, 23 patients (2%) developed ESRD or required acute dialysis, 84 patients (7.3%) developed CKD, 24 patients (2.1%) developed rapidly progressive CKD, and 153 patients (13.3%) died. Researchers also reported that the number of patients who experienced adverse renal outcomes was greater for those who underwent complete versus partial nephrectomy, 12.6% and 7.0%, respectively.
In addition to baseline estimated glomerular filtration rate and the extent of the renal mass removed, proteinuria was a strong independent risk factor for adverse renal outcomes: 42% of patients with proteinuria experienced an adverse renal outcome compared with 9% of those without proteinuria.
“This analysis clearly indicates that adverse renal outcomes that occur after nephrectomy are a competing risk for oncologic outcomes, and in many circumstances total nephrectomy may not be the treatment of choice,” the authors noted in an online report in European Urology. “Renal and overall patient outcomes in addition to oncologic outcomes should be carefully considered when developing a treatment strategy, and nephron-sparing procedures should be the treatment of choice if feasible in patients at risk of developing renal function compromise.”