title: Prognostic factors for renal dysfunction after nephrectomy in renal cell carcinomas.
abstract: OBJECTIVE
  To explore the prognostic factors for renal dysfunction after nephrectomy in patients with renal cell carcinomas.
  
  
  METHODS
  Two hundred twenty-five patients from 2003 to 2010 were analyzed, who have undergone partial nephrectomy or radical nephrectomy for renal tumor, of size ≤4 cm, with normal contralateral kidney. The glomerular filtration rate was computed with the four-variable modification of diet in renal dysfunction (MDRD) criterion. Renal dysfunction was defined as GFR of < 60 mL/min per 1.73 m(2). We applied Cox proportional hazards model to analyze demographic and clinicopathologic parameters to determine the variables independently associated with the development of renal dysfunction.
  
  
  RESULTS
  One hundred twenty-nine out of 225 patients were included in the partial nephrectomy group, while 96 patients were in the radical nephrectomy groups; 97 out of 225 patients developed renal dysfunction: 86 out of 97 in the radical nephrectomy group and 11 out of 97 in the partial nephrectomy group. The 2-y probability of absence of renal dysfunction with partial nephrectomy or radical nephrectomy was 95.7% and 58.3%, respectively (P < 0.001). Among 20 patients with diabetes, 12 (60.0%) developed renal dysfunction: 10 patients underwent an RN and two underwent a PN. The 2-y probability of absence of renal dysfunction with and without diabetes was 46.5% and 76.4%, respectively (P = 0.006). Multivariate analysis showed that age (P = 0.001), type of operation (P < 0.001), preoperative GFR (P = 0.001), and diabetes (P = 0.042) were associated with the development of renal dysfunction.
  
  
  CONCLUSIONS
  The results of this study show that nephron-sparing surgery (NSS) for renal cell carcinomas should be attempted to prevent renal dysfunction in all eligible patients.
authors.affiliation: Department of Urology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, PR China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Xu
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology*; D016896:Treatment Outcome; D055815:Young Adult