The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours.
Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management.
Written by:
Li L, Lau WL, Rhee CM, Harley K, Kovesdy CP, Sim JJ, Jacobsen S, Chang A, Landman J, Kalantar-Zadeh K. Are you the author?
Division of Nephrology and Hypertension, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA; Division of Nephrology, University of Tennessee Health Science Centre, 956 Court Avenue, Memphis, TN 38163, USA; Department of Research, Kaiser Permanente of Southern California, 4700 Sunset Boulevard, Pasadena, CA 90027, USA; Department of Research, Kaiser Permanente of Southern California, 100 S. Los Robles, Pasadena, CA 91101, USA; Department of Pathology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Department of Urology, University of California, Irvine, 333 The City Drive South, Orange, CA 92868, USA.
Reference: Nat Rev Nephrol. 2014 Mar;10(3):135-45.
doi: 10.1038/nrneph.2013.273
PubMed Abstract
PMID: 24419566
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