Renal function and adaptive changes in patients after radical or partial nephrectomy

Int Urol Nephrol. 2012 Jun;44(3):745-51. doi: 10.1007/s11255-011-0058-z. Epub 2011 Sep 21.

Abstract

Introduction: Renal function after renal surgery depends on the volume of renal parenchyma loss and improves in the postoperative period. However, the knowledge on kidney function after radical (RN) and partial (PN) nephrectomy is still insufficient. The aim of this study is to analyze the global renal function and compensatory hyperfunction of the non-operated kidney in patients with renal cancer after RN or PN.

Methods: Fifty-one patients of mean age 62.2 years with renal cancer were included. Thirty-three RN and eighteen PN were performed. We measured creatinine serum concentrations, and we estimated glomerular filtration rate (eGFR) preoperatively and postoperatively at two time intervals: 3 and 12 months after surgery. Additionally, we assessed effective renal plasma flow (ERPF) in dynamic scintigraphy preoperatively and 12 months after surgery.

Result: At the baseline, all mean measured values were comparable in RN and PN groups (P > 0.05). Three months after surgery, creatinine level increased in both groups, more remarkably in RN group (128 mmol/l vs. 95 mmol/l; P < 0.05), while eGFR diminished (47 ml/min/1.73 m(2) vs. 70 ml/min/1.73 m(2); P < 0.05). Similar biochemical values were observed 12 months after surgery. The mean ERPF of the non-operated kidney 12 months after surgery in RN and PN groups increased by 3.8% (232 ml/min) and 0.1% (200 ml/min), respectively (P > 0.05). The mean ERPF of the operated kidney in PN group decreased by 24.7% (149 ml/min).

Conclusion: The deterioration of renal function after partial nephrectomy is nearly insignificant clinically. In 1-year postoperative observation, the renal function does not improve. This causes potential compensatory mechanisms to be insufficient.

MeSH terms

  • Adaptation, Physiological*
  • Adult
  • Aged
  • Chi-Square Distribution
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Kidney / physiology*
  • Kidney / surgery
  • Kidney Neoplasms / surgery*
  • Male
  • Middle Aged
  • Nephrectomy*
  • Postoperative Period
  • Preoperative Period
  • Prospective Studies
  • Renal Plasma Flow, Effective
  • Time Factors

Substances

  • Creatinine