The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy
ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict...
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doaj-a748aa55eef24fad96e425d400bca94d2020-11-25T00:47:06ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-611944474074910.1590/s1677-5538.ibju.2017.0636S1677-55382018000400740The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomyRiccardo BertoloCristian FioriFederico PiramideDaniele AmparoreFrancesco PorpigliaABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382018000400740&lng=en&tlng=enAcute Kidney InjuryNephrectomyCarcinoma, Renal Cell |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Riccardo Bertolo Cristian Fiori Federico Piramide Daniele Amparore Francesco Porpiglia |
spellingShingle |
Riccardo Bertolo Cristian Fiori Federico Piramide Daniele Amparore Francesco Porpiglia The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy International Brazilian Journal of Urology Acute Kidney Injury Nephrectomy Carcinoma, Renal Cell |
author_facet |
Riccardo Bertolo Cristian Fiori Federico Piramide Daniele Amparore Francesco Porpiglia |
author_sort |
Riccardo Bertolo |
title |
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
title_short |
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
title_full |
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
title_fullStr |
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
title_full_unstemmed |
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
title_sort |
preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy |
publisher |
Sociedade Brasileira de Urologia |
series |
International Brazilian Journal of Urology |
issn |
1677-6119 |
description |
ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function. |
topic |
Acute Kidney Injury Nephrectomy Carcinoma, Renal Cell |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382018000400740&lng=en&tlng=en |
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