title: Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy.
abstract: OBJECTIVE
  We analyzed radiographic parameters describing anatomic features of renal tumors to identify preoperative characteristics that could help predict long-term decline in renal function following partial nephrectomy.
  
  
  METHODS
  We retrospectively reviewed the records of 194 consecutive patients who underwent partial nephrectomy from January 2006 to March 2009 and analyzed a cohort of 53 patients for whom complete clinical, radiographic, and operative information was available. Computed tomography images were reviewed by a single radiologist. Radiographic criteria for describing renal tumor size and location included diameter, volume, endophytic properties, proximity to collecting system, anterior/posterior location, location relative to polar lines, and R.E.N.A.L. nephrometry score. Postoperative estimated glomerular filtration rate was calculated using the MDRD study group equation with serum creatinine at last follow-up.
  
  
  RESULTS
  The median preoperative and postoperative GFR values were 75 (IQR 65-97) and 66 (IQR 55-84) mL/min/1.73 m(2), respectively. At a median follow-up of 38 months, the median percentage decrease in GFR was 12%. On univariate analyses, tumor diameter (P = 0.002), tumor volume (P < 0.0001), nearness of tumor to collecting system (P = 0.017), and location relative to polar lines (P = 0.017) were associated with percentage decrease in GFR. Furthermore, higher R.E.N.A.L. nephrometry score was also associated with poorer renal functional outcomes following partial nephrectomy (P = 0.019).
  
  
  CONCLUSIONS
  Anatomic features of renal tumors defined by preoperative radiographic characteristics correlate with the degree of renal functional decline after partial nephrectomy. Identification of these parameters may assist in patient counseling and clinical decision making following partial nephrectomy. Validation in larger prospective studies is necessary.
authors: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, Starr 900, 525 East 68th St., Box 94, New York, NY 10065, USA. euc9010@nyp.org
authors: Eugene K
authors: EK
authors: Cha
authors: Casey K
authors: CK
authors: Ng
authors: Bryan
authors: B
authors: Jeun
authors: Allison
authors: A
authors: Dunning
authors: Jennifer E
authors: JE
authors: Reifsnyder
authors: James R
authors: JR
authors: DiPietro
authors: Madhu
authors: M
authors: Mazumdar
authors: George
authors: G
authors: Shih
authors: Yong H
authors: YH
authors: Auh
authors: Joseph J
authors: JJ
authors: Del Pizzo
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Douglas S
authors: DS
authors: Scherr
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