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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 680-685. doi: 10.19723/j.issn.1671-167X.2021.04.010

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Renal functional compensation after unilateral radical nephrectomy of renal cell carcinoma

HAN Song-chen,HUANG Zi-xiong,LIU Hui-xin,XU Tao   

  1. Department of Urology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2021-03-14 Online:2021-08-18 Published:2021-08-25
  • Contact: Tao XU

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Abstract:

Objective: To investigate factors influencing renal functional compensation(RFC) of the preserved kidney after radical nephrectomy (RN). Methods: A total of 286 patients treated with RN in Peking University People’s Hospital were retrospectively analyzed. Preoperative body mass index (BMI), systolic blood pressure (SBP), history of smoking, history of chronic diseases and other basic information, as well as preoperative blood biochemistry, urine routine, imaging examination results were recorded. All the patients underwent 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scans before operation. The surgical method, pathology and blood creatinine values from 1 month to 60 months after RN were recorded. Preoperative and postoperative estimated glomerular filtration rate (eGFR) was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal functional compensation was defined as percent change in eGFR of the preserved kidney after RN compared with the preoperative eGFR. Univariate and multivariate regression analyses were used to identify predictive factors of RFC. Results: Median age was 61 years and 65.4% of the patients were male. Early stage (T1 or T2) tumors were found in 83.6% of the cases. 18.5% of the patients had preoperative diabetes mellitus, 39.5% had hypertension, 19.2% had a history of smoking, and 27.6% were found to have renal cyst on the contralateral side. In the study, 226 cases underwent laparoscopic radical nephrectomy and 60 cases underwent open radical nephrectomy. Renal clear cell carcinoma was the most common pathological type, accounting for 88.5%. The median tumor maximum diameter was 4.5 cm (0.7-13.5 cm). Median renal function compensation was 27% one month after radical nephrectomy. Functional stability was then observed to 5 years. The results of univariate analysis showed that age, gender, preoperative blood uric acid, preoperative urine protein, contralateral renal cyst, and percentage of split renal function of contralateral kidney were correlated with RFC (P<0.05). Among them, UA level and split renal function of contralateral kidney were strongly negatively correlated with RFC. The results of multivariate linear regression analysis showed age (P<0.001), blood uric acid (P<0.001), urine protein (P=0.002), preoperative eGFR (P<0.001) and the split renal function of contralateral kidney (P<0.001) were independent predictors of RFC. Conclusion: The basic examinations, such as blood biochemistry, urine routine and renal scan before RN are of great significance in predicting the compen-satory ability of the preserved kidney after RN, which is supposed to be taken into consideration when making clinical decision.

Key words: Renal cell carcinoma, Radical nephrectomy, 99mTc-DTPA renal dynamic imaging, Renal functional compensation

CLC Number: 

  • R737.11

Table 1

Preoperative patient characteristics"

Items Data
Age/years, M (range) 61 (22-85)
Gender, n(%)
Male 187 (65.4)
Femal 99 (34.6)
BMI/(kg/m2), M (range) 24.91 (16.59-41.97)
SBP/mmHg, M (range) 131 (86-188)
Concomitant diabetes mellitus, n(%)
Yes 53 (18.5)
No 233 (81.5)
Concomitant hypertension, n(%)
Yes 113 (39.5)
No 173 (60.5)
Smoking status, n(%)
Current or former 74 (25.9)
Never 212 (74.1)
Alcohol intaking, n(%)
Current or former 55 (19.2)
Never 231 (80.8)
Glucose/(mmol/L), M (range) 5.35 (3.49-13.45)
BUN/(mmol/L), M (range) 5.00 (2.58-16.52)
Scr/((mol/L), M (range) 73 (38-315)
UA/((mol/L), M (range) 329 (107-655)
eGFR [mL/(min·1.73 m2), M (range) 92.35 (17.16-141.88)
SG, M (range) 1.015 (1.000-1.040)
Preoperative proteinuria, n(%)
Positive 37 (12.9)
Negtive 249 (87.1)
Renal cyst of contraleteral side, n(%)
≥1 79 (27.6)
0 207 (72.4)
Renal cyst of affected side, n(%)
≥1 82 (28.7)
0 204 (71.3)
Maximum diameter of tumors/cm, M (range) 4.5 (0.7-13.5)
Histology, n(%)
Clear cell 253 (88.5)
Papillary 6 (2.1)
Chromophobe 9 (3.1)
Others 18 (6.3)
T stage, n(%)
T1 227 (79.4)
T2 12 (4.2)
T3 46 (16.1)
T4 1 (0.3)
Nephrectomy, n(%)
Laparoscopic 226 (79.0)
Open 60 (21.0)

Figure 1

Bland-Altman plot of preoperative eGFR and rGFR SD, standard deviation; eGFR, estimated glomerular filtration rate; rGFR, reference glomerular filtration rate."

Table 2

Preoperative and postoperative renal function measurements"

Items Data
Preoperative
CKD stage, n(%)
Grade 1: eGFR≥90 mL/(min·1.73 m2) 165 (57.7)
Grade 2: eGFR 60-89 mL/(min·1.73 m2) 101 (35.3)
Grade 3: eGFR 30-59 mL/(min·1.73 m2) 18 (6.3)
Grade 4: eGFR 15-29 mL/(min·1.73 m2) 2 (0.7)
eGFR/[mL/(min·1.73 m2)], M (range)
Global 92.3 (17.2-141.9)
Contraleteral kidney 46.6 (9.41-93.3)
Affected kidney 44.9 (7.7-74.0)
rGFR/[mL/(min·1.73 m2)], M (range)
Global 91.2 (24.8-185.30)
Contraleteral kidney 47.4 (14.2-88.7)
Affected kidney 45.2 (8.8-103.5)
Split renal function/%, M (range)
Contraleteral kidney 51 (26-83)
Affected kidney 49 (17-74)
Postoperateve
eGFR/[mL/(min·1.73 m2)], M (range)
1 months 64.1 (15.0-107.0)
3-12 months 63.3 (17.4-123.1)
18-36 months 63.2 (6.3-119.3)
48-60 months 66.6 (6.0-118.0)
RFC/%, M (range)
1 months 27 (-25-67)
3-12 months 28 (-36-69)
24-36 months 26 (-54-60)
48-60 months 26 (-56-70)

Table 3

Predictors of percent renal functional compensation after radical nephrectomy"

Items Univariable Multivariable
Coefficient P value Coefficient Standard error Standardized coefficient P value
Age -0.004 0.042 -0.009 0.002 -0.313 <0.001
Gender (Male vs. Female) 0.129 0.004 0.070 0.043 0.094 0.099
BMI -0.004 0.519 0.001 0.005 0.014 0.794
Smoking (Yes vs. No) 0.001 0.977 0.005 0.044 0.006 0.914
Hypertension (Yes vs. No) -0.017 0.704 -0.003 0.039 -0.004 0.937
Diabetes mellitus (Yes vs. No) -0.087 0.112 -0.053 0.048 -0.058 0.266
Preoperative UA -0.001 <0.001 -0.001 0.218×10-3 -0.305 <0.001
Preoperative proteinuria (Yes vs. No) -0.145 0.021 -0.093 0.029 0.157 0.002
Renal cyst of contraleteral side (Yes vs. No) -0.114 0.016 -0.075 0.040 -0.094 0.060
Preoperative eGFR -0.001 0.210 -0.008 0.001 -0.420 <0.001
Split renal function of contraleteral kidney -1.878 <0.001 -2.092 0.250 -0.424 <0.001

Figure 2

Correlation between the renal functional compensation and preoperative renal function as well as split renal function"

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