Korean J Urol.  2013 May;54(5):303-310. 10.4111/kju.2013.54.5.303.

Predictive Preoperative Factors for Renal Insufficiency in Patients Followed for More Than 5 Years After Radical Nephrectomy

• Ahn JS
• Kim HJ
• Jeon HG
• Jeong BC
• Seo SI
• Lee HM
• Choi HY
• Jeon SS

• KMID: 2061511
• DOI: http://doi.org/10.4111/kju.2013.54.5.303

Abstract

PURPOSE
We assessed the predictive factors for renal insufficiency in patients followed for more than 5 years after radical nephrectomy.
MATERIALS AND METHODS
Age, gender, history of diabetes, history of hypertension, body mass index, preoperative estimated glomerular filtration rate (eGFR), serum uric acid, urine albumin, normal renal parenchymal volume, tumor size, and ratio of normal parenchymal volume of the removed kidney to that of the remaining kidney were evaluated retrospectively in 89 patients who underwent radical nephrectomy from January 2001 to December 2005. Patients were included whose renal parenchymal volume was measurable by use of perioperative imaging (computed tomography or magnetic resonance imaging), whose preoperative eGFR was greater than 60 mL/min/1.73 m2, and who were followed for more than 5 years. To measure renal parenchymal volume from imaging, we integrated the extent of the normal renal parenchyma from axial slides of images.
RESULTS
In univariate and multivariate binary regression analysis, the parenchymal volume of the remnant kidney (p=0.001), a history of diabetes (p=0.035), and preoperative eGFR (p=0.011) were independent factors for renal insufficiency. By use of a receiver operating characteristic curve, a volume of 170 mL was determined to be an appropriate cutoff value, with sensitivity of 58.7% and specificity of 74.4% for the parenchymal volume of the remnant kidney for predicting eGFR less than 60 mL/min/1.73 m2 (area under the curve, 0.678). The parenchymal volume of the remnant kidney was also an independent factor for the downgrading of the chronic kidney disease category in the multivariate linear regression analysis (p=0.021).
CONCLUSIONS
Preoperative eGFR, a history of diabetes, and the radiologic volume of the remaining kidney parenchyma could be useful factors for predicting postoperative renal function. Patients with parenchymal volumes of less than 170 mL have a higher risk of postoperative renal insufficiency, which should be considered carefully when choosing a treatment modality.

Keyword

Kidney; Nephrectomy; Organ size; Renal insufficiency

MeSH Terms

Body Mass Index
Glomerular Filtration Rate
Humans
Hypertension
Kidney
Linear Models
Magnetic Resonance Spectroscopy
Nephrectomy
Organ Size
Renal Insufficiency
Renal Insufficiency, Chronic
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Tumor Burden
Uric Acid
Uric Acid

Figure

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  FIG. 1 Kidney volume was assessed using personal computer-based software (PACS; Centricity Enterprise Web ver. 3.0). The volume was calculated by integrating the extent of normal functioning tissue, excluding tumours or nonenhanced areas, from the axial side of the computed tomography (CT) or magnetic resonance imaging (MRI) images with a slice thickness of 5 mm for patients who underwent radical nephrectomy before surgery (A) delayed CT axial image (B) T2 weighted MRI axial image.

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  FIG. 2 Receiver operating characteristic (ROC) curve based on parenchymal volume of remnant kidney volume. CI, confidence interval.

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