The Pre-operative Clinical Predictors for Renal Insufficiency Developing after Radical Nephrectomy in the Patients with Contralateral Normal Kidney.
- Author:
Jin Rae ROH
1
;
Soo Eung CHAI
;
Han Yong CHOI
Author Information
1. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hychoi@smc.samsung.co.kr
- Publication Type:Original Article
- Keywords:
Radical nephrectomy;
Renal insufficiency;
Creatinine;
Contralateral normal kidney
- MeSH:
Carcinoma, Renal Cell;
Creatinine;
Diabetes Mellitus;
Female;
Humans;
Hypertension;
Incidence;
Kidney*;
Male;
Multivariate Analysis;
Nephrectomy*;
Renal Dialysis;
Renal Insufficiency*;
Sexuality
- From:Korean Journal of Urology
2002;43(8):645-650
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.
