title: Kidney function after partial nephrectomy:  current thinking.
abstract: OBJECTIVE
  With clinical guidelines recommending partial nephrectomy for small renal masses, it is essential to understand the benefits of partial nephrectomy in regards to renal function. Our objective was to review current evidence and highlight emerging issues for partial nephrectomy and renal function.
  
  
  RESULTS
  A recent clinical trial of partial and radical nephrectomy found minimal differences in survival or adverse renal sequelae. However, most observational studies and systematic reviews suggest that partial nephrectomy decreases the risks of adverse renal function, in particular, new-onset severe chronic kidney disease, and improves overall survival. Key features associated with long-term renal function include treatment modality (observation, ablation, surgery), ischemia type and duration, amount of healthy renal preservation, and baseline renal function.
  
  
  CONCLUSIONS
  Partial nephrectomy should remain the standard of care for small renal masses, if the renal tumor size and complexity are amenable to such a surgical approach. Efforts to minimize ischemia time are important for long-term renal functional recovery, and hypothermia should be considered if longer warm ischemia times are anticipated (i.e. >25 min). Although the preliminary results of zero ischemia partial nephrectomy are promising, further research is needed to determine if these surgical techniques are safely adaptable in the broader urologic community.
authors: Mayo Clinic, Department of Urology, Rochester, MN 55905, USA.
authors: Simon P
authors: SP
authors: Kim
authors: R Houston
authors: RH
authors: Thompson
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000098:blood supply; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome