title: Renal function following curative surgery for renal cell carcinoma: who is at risk for renal insufficiency?
abstract: OBJECTIVE
  To investigate the incidence and predictive factors associated with the development of chronic kidney disease (CKD) in patients undergoing curative surgery for renal cell carcinoma.
  
  
  METHODS
  From 2003 to 2010, we retrospectively investigated 108 patients undergoing partial nephrectomy or radical nephrectomy (RN) for renal tumors with a preoperative glomerular filtration rate (GFR)≥60. The GFR was calculated by use of the four-variable modification of diet in renal disease (MDRD) formula. CKD was defined as an estimated GFR (eGFR) less than 60 mL/min per 1.73 m(2). Demographic and clinicopathologic parameters were evaluated by using the chi-square and Student t-tests and multivariate regression analysis to determine the variables independently associated with the development of postoperative CKD.
  
  
  RESULTS
  Of the 108 patients without preoperative CKD, CKD developed in 43 patients (39.8%). In the analysis of clinical factors between patients with and those without CKD development, gender, body mass index, diabetes mellitus, hypertension, and tumor size were not significant clinical factors. Statistical significance for CKD development was found for age of 60 years or greater (p=0.013), decreased preoperative eGFR (p<0.001), and RN group (p<0.001). In the multivariate analysis, decreased preoperative eGFR (p=0.001) and RN group (p=0.002) were significant independent predictors.
  
  
  CONCLUSIONS
  The results of our study show that decreased preoperative renal function and RN were significant independent predictors of postoperative CKD. In patients who had a relatively decreased preoperative eGFR, especially when estimated by use of the MDRD formula, nephron-sparing surgery should be considered for the treatment of small renal tumors.
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Hyuk Jun
authors.initials: HJ
authors.lastname: Kong
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Jae Shin
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Duk Yoon
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Shin
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
keywords: Chronic kidney disease; Glomerular filtration rate; Renal cell carcinoma