Radical Nephrectomy Increases Risk of Chronic Kidney Disease

Radical Nephrectomy Increases Risk of Chronic Kidney Disease

In patients undergoing surgery for the treatment of small kidney tumors, radical nephrectomy is linked with a higher risk of chronic kidney disease than partial nephrectomy. These results were published in the journal Lancet Oncology.

The kidneys are each filled with tiny tubules that clean and filter the blood-the process that removes waste and makes urine. Renal cell cancer (RCC) is a malignancy involving these tubules of the kidney.

Treatment of patients with renal cell cancer generally includes surgery unless patients are too ill to tolerate the procedure. Two common types of surgery are radical nephrectomy and partial nephrectomy.

A radical nephrectomy refers to the complete removal of the involved kidney, adjacent fat, adrenal gland, and/or any involved lymph nodes or major vasculature. A partial nephrectomy refers to the removal of the tumor and some surrounding normal tissue.

To explore the risk of chronic kidney disease after surgery in patients with small kidney tumors, researchers reviewed the records of 662 patients who had undergone either radical nephrectomy or partial nephrectomy. The study was restricted to patients who had a solitary kidney tumor that was no more than 4 cm in size. All patients had a healthy second kidney.

Patients were classified as having kidney disease if they developed a low glomerular filtration rate (GFR). A low GFR was defined as 60 mL/min per 1.73 m2.

  • 26% of patients were found to have pre-existing kidney disease (kidney disease that had developed prior to surgery).
  • During the three years after surgery, 80% of patients treated with partial nephrectomy remained free of new kidney disease, compared to 35% of patients treated with radical nephrectomy.
  • After accounting for other factors that may influence the probability of kidney disease, patients treated with radical nephrectomy were almost four times more likely to develop kidney disease than patients treated with partial nephrectomy.

The researchers conclude that radical nephrectomy increases the risk of chronic kidney disease, and may not be the optimal approach for patients with small, isolated kidney tumors.

Reference: Huang WC, Levey AS, Serio AM et al. Chronic Kidney Disease after Nephrectomy in Patients with Renal Cortical Tumours: A Retrospective Cohort Study. Lancet Oncology. 2006;7:735-40.

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