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UPJ INSIGHT Short- and Long-Term Renal Function After Partial Nephrectomy: Solitary vs Multifocal Renal Masses
By: Lachlan Shiver, BS,* University of South Florida Morsani College of Medicine, Tampa; R. Barry Sirard, BS,* University of South Florida Morsani College of Medicine, Tampa; Philippe E. Spiess, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Firaas Khan, BS, University of South Florida Morsani College of Medicine, Tampa; Brandon J. Manley, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Chen Wang, BS, University of South Florida Morsani College of Medicine, Tampa; Logan Zemp, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Claude Bassil, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Heather L. Huelster, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, Indiana University Health, Indianapolis *Co-first authors. | Posted on: 18 Mar 2024
Shiver L, Sirard RB, Spiess PE, et al. Short- and long-term renal function after partial nephrectomy: comparison of solitary and multifocal renal masses. Urol Pract. 2024;11(2):347-355.
Study Need and Importance
AUA guidelines recommend a nephron-sparing approach in patients with hereditary renal cell carcinoma who present with multifocal renal masses. This approach seeks to preserve renal function in the setting of potentially multiple surgeries throughout one’s lifetime. However, the paucity of data assessing long-term renal outcomes in this surgical approach can be detrimental to patient counseling and management strategies.
What We Found
In patients with multifocal renal masses, a nephron-sparing approach resulted in a slightly greater decline in renal function when compared to patients with matched unifocal masses (Table). This decline stabilized within 24 to 36 months, and the difference never reached clinical significance. Oncological and survival outcomes also did not significantly differ between cohorts.
Table. Bayesian Mixed Model Analysis of Perioperative Characteristics and Glomerular Filtration Rate After Partial Nephrectomy
| Standard (N = 192) | Multifocal (N = 64) | Estimated difference (95% CI) | |
|---|---|---|---|
| Estimated blood loss, median (mL) | 150 | 275 | 0.48 (0.2, 0.8) |
| Ischemia time, median (min) | 19 | 21 | –0.16 (–0.4, 0.1) |
| 30-Day complication rate, No. (%) | 22 (11) | 12 (19) | 0.58 (–0.2, 1.4) |
| Median GFR at 1-3 mo, median (mL/min) | 68.8 | 68.2 | –5.74 (–10.4, –0.9) |
| Median GFR at 6 mo, median (mL/min) | 70.4 | 60.6 | –7.83 (–13.4, –2.4) |
| Median GFR at 9-12 mo, median (mL/min) | 76.3 | 67.7 | –5.69 (–10.2, –1.1) |
| Median GFR at 24 mo, median (mL/min) | 74.4 | 70.9 | –1.11 (–6.5, 4.3) |
| Median GFR at 36 mo, median (mL/min) | 71.6 | 68.2 | –3.41 (–9.3, 2.4) |
| Abbreviations: GFR, glomerular filtration rate. Bolded text indicates a statistically significant value. |
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Limitations
This study was a single-center retrospective design, which both increases the risk of attrition bias and decreases generalizability. Differences in surgical approach were not considered in matching our cohorts, which may have impacted the amount of renal parenchyma removed during surgery. Lastly, the calculation of estimated glomerular filtration rate from serum creatinine can lack precision before chronic kidney disease stage III.
Interpretation for Patient Care
A nephron-sparing approach to multifocal renal masses should be sought whenever clinically feasible, as this approach offers similar functional renal outcomes to matched unifocal renal masses.
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