Objective: To investigate the time-dependent changes of estimated glomerular filtration rate (eGFR) after radical nephrectomy (RN) and partial nephrectomy (PN) for renal cell carcinoma (RCC) and to determine the risk factors for the new onset of a postoperative eGFR <60 ml/min/1.73 m2. Patients and Methods: We assessed the renal function of 253 RCC patients by using the eGFR, and investigated the time-dependent changes of the eGFR after the operation. Regression models were used to determine risk factors for the new onset of an eGFR of <60 ml/min/1.73 m2 in 211 patients who had at least one month of postoperative follow-up. Results: From the first postoperative day to the 60th postoperative month the eGFR in the RN group was significantly lower than that in the PN group. For patients who had at least 1 month of postoperative follow-up, multivariable analysis revealed that RN (p < 0.001), age (p = 0.028), and maleness (p = 0.013) were risk factors for the postoperative onset of an eGFR <60 ml/min/1.73 m2. Conclusions: Renal function after PN was better than that after RN, and RN was a greater risk factor for the postoperative onset of an eGFR <60 ml/min/ 1.73 m2.

Keywords:
Partial nephrectomy, Radical nephrectomy, Renal cell carcinoma
1.
Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H: Matched comparison of radical nephrectomy vs. nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000;75:1236–1242.
2.
Pahernik S, Roos F, Hampel C, Gillitzer R, Melchior SW, Thüroff JW: Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience. J Urol 2006;175:2027–2031.
3.
McKiernan J, Simmons R, Katz J, Russo P: Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002;59:816–820.
4.
Tanaka N, Fujimoto K, Tani M, et al: Prediction of postoperative renal function by preoperative serum creatinine level and three-dimensional diagnostic image reconstruction in patients with renal cell carcinoma. Urology 2004;64:904–908.
5.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G: National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147.
6.
Imai E: Equation for estimating GFR from creatinine in Japan. Nippon Rinsho 2008;66:1725–1729.
7.
Sharma N, O’Hara J, Novick AC, Lieber M, Remer EM, Herts BR: Correlation between loss of renal function and loss of renal volume after partial nephrectomy for tumor in a solitary kidney. J Urol 2008;179:1284–1288.
8.
Süer E, Burgu B, Gökce Mİ, Türkölmez K, Bedük Y, Baltaci S: Comparison of radical and partial nephrectomy in terms of renal function: a retrospective cohort study. Scand J Urol Nephrol 2011;45:24–29.
9.
Barlow LJ, Korets R, Laudano M, Benson M, McKiernan J: Predicting renal functional outcomes after surgery for renal cortical tumours: a multifactorial analysis. BJU Int 2009;106:489–492.
10.
Huang WC, Levey AS, Serio AM Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P: Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 2006;7:735–740.
11.
Kim HL, Shah SK, Tan W, Shikanov SA, Zorn KC, Shalhav AL, Wilding GE: Estimation and prediction of renal function in patients with renal tumor. J Urol 2009;181:2451–2460.
12.
Lesage K, Joniau S, Fransis K, Van Poppel H: Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol 2007;51:614–620.
13.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999;130:461–470.
14.
Matsuo S, Imai E, Horio M yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A: Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982–992.
15.
Hazebroek EJ, de Bruin RW, Bouvy ND, Marquet RL, Bonthuis F, Bajerna IM, Hayes DP, Ijzermans JM, Bonjer HJ: Long-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient rats. Ann Surg 2003;237:351–357.
16.
Song C, Bang JK, Park HK, Ahn H: Factors influencing renal function reduction after partial nephrectomy. J Urol 2009;181:48–54.
17.
Anderson RG, Bueschen AJ, Lloyd LK, Dubovsky EV, Burns JR: Short-term and long-term changes in renal function after donor nephrectomy. J Urol 1991;145:11–13.
18.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
19.
Fried LF, Katz R, Sarnak MJ, Shlipak MG, Chaves PH, Jenny NS, Stehman-Breen C, Gillen D, Bleyer AJ, Hirsch C, Siscovick D, Newman AB: Kidney function as a predictor of noncardiovascular mortality. J Am Soc Nephrol 2005;16:3728–3735.
20.
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003;42:1050–1065.
21.
Matsushita K, van der Velde M, Astor BC, et al: Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375:2073–2081.
22.
Funahashi Y, Hattori R, Yamamoto T, Kamihira O, Moriya Y, Gotoh M: Change in contralateral renal parenchymal volume 1 week after unilateral nephrectomy. Urology 2009;74:708–712.
23.
Clark MA, Shikanov S, Raman JD Smith B, Kaag M, Russo P, Wheat JC, Wolf JS, Martin SF, Huang WC, Shalhav AL, Eggener SE: Chronic kidney disease before and after partial nephrectomy. J Urol 2011;185:43–48.
24.
Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, Blute ML: Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 2008;179:468–471.
25.
Neugarten J: Gender and the progression of renal disease. J Am Soc Nephrol 2002;13:2807–2809.
26.
Neugarten J, Acharya A, Silbiger SR: The effect of gender on the progression of non-diabetic renal disease: a meta-analysis. J Am Soc Nephrol 2000;11:319–329.
27.
Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, Kiyohara Y, Makino H, Hishida A, Matsuo S: Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res 2008;31:433–441.
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2012
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