title: Predictive factors for impaired renal function following nephroureterectomy in upper urinary tract urothelial cell carcinoma.
abstract: OBJECTIVE
  Despite the uncertain value of adjuvant chemotherapy after radical nephroureterectomy (RNU) it is clear that impaired renal function represents a contraindication to its administration. The objective of this study was to identify possible predictive clinical factors for impaired renal function following RNU in patients with upper urinary tract urothelial cell carcinoma (UUT-UCC).
  
  
  METHODS
  A retrospective analysis was conducted of 546 patients who underwent RNU between 1992 and 2008 at our institution. Data of interest for this study included estimated glomerular filtration rate (eGFR), age, pathological stage and preoperative hydronephrosis (HN). The predictive value of HN, age and pathological stage for impaired renal function after RNU was calculated by multivariate linear regression analysis.
  
  
  RESULTS
  In total, 138 patients met the criteria for inclusion, including 108 men (78%). Mean age at surgery was 67 ± 10 years. There was a significant correlation (p < 0.001) between pre- and postoperative eGFR (decrease of 21% after NU). Preoperative HN was present in 51 patients (37%). On linear regression analysis, preoperative eGFR ≤60 ml/min (p = 0.012; OR = 4.60) and HN (p = 0.027; OR = 10.34) were confirmed to be predictive factors for a postoperative eGFR ≤60 ml/min. When postoperative eGFR ≤45 ml/min was used as the criterion for impaired renal function, predictive factors proved to be preoperative eGFR ≤45 ml/min (p < 0.0001; OR = 18.53), HN (p = 0.038; OR = 0.380) and age ≥70 years (p < 0.0001; OR = 0.169).
  
  
  CONCLUSIONS
  Preoperative HN, older age and preoperative eGFR <60 ml/min were proven to be predictive factors for impaired renal function after RNU. In these settings, neoadjuvant chemotherapy may be considered.
authors.affiliation: Department of Urology, Universitat Autònoma de Barcelona, Fundació Puigvert, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Rodríguez Faba
authors.forename: J
authors.initials: J
authors.lastname: Palou
authors.forename: A
authors.initials: A
authors.lastname: Breda
authors.forename: P
authors.initials: P
authors.lastname: Maroto
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández Gómez
authors.forename: A
authors.initials: A
authors.lastname: Wong
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D009392:Nephrectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects; D019459:Urothelium / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents