Residual renal function after partial or radical nephrectomy for renal cell carcinoma

Authors

  • David Chapman Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB; Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB
  • Ron Moore Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB; Department of Oncology, University of Alberta, Edmonton, AB
  • Scott Klarenbach Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB
  • Branko Braam Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB; Department of Physiology, University of Alberta, Edmonton, AB

DOI:

https://doi.org/10.5489/cuaj.909

Abstract

Renal cell carcinoma (RCC) is often detected incidentally and
early. Currently, open partial nephrectomy and laparoscopic total
nephrectomy form competing technologies. The former is invasive,
but nephron-sparing; the other is considered less invasive but with
more loss of renal mass. Traditionally, emphasis has been placed
on oncologic outcomes. However, a patient with an excellent
oncologic outcome may suffer from morbidity and mortality related
to renal failure. Animal models with hypertension and diabetic
renal disease indicate accelerated progression of pre-existing disease
after nephrectomy. Patients with RCC are older and they have
a high prevalence of diabetes and hypertension. The progression
of renal failure may also be accelerated after a nephrectomy. Our
analysis of the available literature indicates that renal outcomes in
RCC patients after surgery are relatively poorly defined. A strategy
to systematically evaluate the renal function of patients with RCC,
with joint discussion between the nephrologist and the oncologic
team, is strongly advocated.

L’hypernéphrome est souvent décelé fortuitement et au stade précoce.
Actuellement, la néphrectomie partielle par voie ouverte
et la néphrectomie totale par laparoscopie sont des technologies
concurrentes. Tandis que la première est plus invasive, mais permet
l’épargne des néphrons, la seconde est moins invasive mais
entraîne une perte plus importante de masse rénale. Par le passé,
on a mis l’emphase sur les résultats d’un point de vue oncologique.
Cependant, un patient pour qui la chirurgie donne d’excellents résultats
en matière d’élimination de la tumeur pourrait présenter une
morbidité et une mortalité en lien avec une insuffisance rénale. Des
modèles animaux de néphropathie avec hypertension et diabète
indiquent une évolution accélérée des maladies préexistantes après
la néphrectomie. Les patients présentant un hypernéphrome sont
plus âgés; la prévalence du diabète et de l’hypertension est élevée.
L’évolution de l’insuffisance rénale peut aussi être accélérée après
la néphrectomie. Notre analyse des articles publiés montre que les
résultats sur le plan de la fonction rénale après une chirurgie pour
traiter un hypernéphrome sont relativement mal définis. Une stratégie
fondée sur une évaluation systématique de la fonction rénale des
patients atteints d’hypernéphrome, avec discussion entre le néphrologue
et l’équipe de soins oncologiques, est fortement encouragée.

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Author Biographies

David Chapman, Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB; Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB

Ron Moore, Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB; Department of Oncology, University of Alberta, Edmonton, AB

Scott Klarenbach, Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB

Branko Braam, Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB; Department of Physiology, University of Alberta, Edmonton, AB

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How to Cite

Chapman, D., Moore, R., Klarenbach, S., & Braam, B. (2013). Residual renal function after partial or radical nephrectomy for renal cell carcinoma. Canadian Urological Association Journal, 4(5), 337–43. https://doi.org/10.5489/cuaj.909

Issue

Vol. 4 No. 5 (2010): CUAJ October

Section

Review

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