Predictive factors for the development of renal insufficiency following partial nephrectomy and subsequent renal function recovery: A multicenter retrospective study

Abstract

Patients who undergopartialnephrectomy(PN) may exhibitrenalfunctioninsufficiency, and a subset of these patients achievesrenalfunctionrecovery. We evaluated the predictors ofrenalinsufficiencyandsubsequentrenalfunctionrecoveryfollowingPN. Data on 393 patients who underwent PN for solidrenaltumors between March 2001 and November 2013, obtained from 6 institutions, were retrospectively reviewed.Renalinsufficiencywas defined as new onset of chronic kidney disease stage ≥3 postoperatively on the second of 2 consecutive tests.Renalfunctionrecoverywas defined as an estimated glomerular filtration rate ≥60 ml/minute/1.73 mfollowingrenalinsufficiency. Tumor complexity was stratified according to theRENALclassification system. The median (interquartile range) age, tumor size, and follow-up period were 53 (45-63) years, 2.6 (1.9-3.8) cm, and 36 (12-48) months, respectively. Tumors were of low complexity in 258/393 (65.6%) of cases.Renalinsufficiencydeveloped in 54/393 (13.5%) patients, in which age ≥60 years and preoperative creatinine ≥1.1 mg/ml were independent predictors. Tumor complexity, clamp type, and operative method were not significant prognosticfactors. Among patients with newly developedrenalinsufficiency, 18/54 (33.3%) patients exhibitedrenalfunctionrecoverywithin a median period of 18 months, of which preoperative creatinine <1.1 mg/ml was an independent predictor. Age ≥60 years and preoperative creatinine ≥1.1 mg/ml were riskfactorsforrenalinsufficiencyfollowingPN. Patients withrenalinsufficiencywhose preoperative creatinine was <1.1 mg/ml were likely to haverenalfunctionrecovery.