Chronic kidney disease after radical nephrectomy for suspected renal cancers

Table 1 The incidence or prevalence of chronic kidney disease or end-stage renal disease before and after radical or partial nephrectomy for suspected renal cancers

Population	Incidence or prevalence	Ref.
CKD in patients with T1a RCC before surgery	26%	Huang et al[2]
New-onset CKD after radical nephrectomy (SEER-Medicare database)	20%	Sun et al[10]
New-onset CKD after partial nephrectomy (SEER-Medicare database)	11%	Sun et al[10]
ESRD after radical nephrectomy	2%-4%	Sun et al[10]
		Scosyrev et al[11]
ESRD after partial nephrectomy	2%	Sun et al[10]

CKD: Chronic kidney disease; ESRD: End-stage renal disease; RCC: Renal cell carcinoma; SEER: Surveillance, Epidemiology and End Results.

Table 2 Risk factors associated with new-onset chronic kidney disease or acceleration of pre-existing chronic kidney disease after radical nephrectomy

Risk factor	Odds ratio (95%CI); P-value	Ref.
Diabetes mellitus	11.60 (1.39-97.04); P = 0.024	Brandina et al[24]
	2.74 (1.07-6.98); P = 0.035	Cho et al[30]
Hypertension	3.67 (1.28-10.48); P = 0.015	Brandina et al[24]
Low preoperative GFR (< 90 mL/min per 1.73 m2)	3.30 (1.16-9.37); P = 0.025	Brandina et al[24]
Preoperative GFR (per 10 mL/min per 1.73 m2 rise)	0.47 (0.36-0.60); P = 0.0001	Cho et al[30]
Postoperative AKI	4.24 (2.28-7.89); P = 0.0001	Cho et al[30]
Adjacent non-neoplastic kidney parenchyma abnormalities
Arteriosclerosis > 50%	3.33 (1.03-10.79); P = 0.045	Brandina et al[24]
Interstitial fibrosis (present)	3.78 (1.32-10.76); P = 0.013
Glomerulosclerosis ≥ 5%	3.78 (1/24-11.50); P = 0.0061

AKI: Acute kidney injury; GFR: Glomerular filtration rate.

Table 3 Questions to be addressed by future studies

How is long-term cardiovascular health affected by radical nephrectomy?

What is the incidence of end-stage renal disease and renal replacement therapy after radical or partial nephrectomy?

What reliable investigations can be used to identify patients with renal cell carcinoma prior to surgery?

How does the contralateral kidney compensate after radical nephrectomy?

How can kidney function be preserved after nephrectomy?