title: Chronic renal insufficiency after partial nephrectomy for T1b tumors.
abstract: OBJECTIVE
  Partial nephrectomy for larger kidney tumors (T1b) has gained widespread acceptance in most academic institutions, with similar oncologic outcomes to radical nephrectomy. This review focuses on the factors that affect renal function after partial nephrectomy, and presents current information about the relative importance of each factor as well as chronic kidney disease (CKD) after renal surgery.
  
  
  RESULTS
  CKD occurs over the long term in a significant percentage of patients following partial nephrectomy. The interaction of different factors including baseline kidney function (influenced by age and medical comorbidity), amount of preserved renal parenchyma (influenced by surgical technique), and ischemia time (warm or cold) determines the ultimate functional outcome. De-novo CKD resulting from surgery in previously healthy individuals may not place these patients at increased risk of progression or mortality.
  
  
  CONCLUSIONS
  Urologists continue to strive towards improved kidney function after partial nephrectomy, particularly for larger tumors. Careful identification of factors involved in functional outcome, and optimization of modifiable factors, will remain at the forefront of efforts to minimize renal functional loss after partial nephrectomy.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. Fergana@ccf.org
authors.forename: Amr
authors.initials: A
authors.lastname: Fergany
mesh_terms: D050377:Cold Ischemia / Q000009:adverse effects; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D052096:Warm Ischemia / Q000009:adverse effects