title: Compensatory hypertrophy after partial and radical nephrectomy in adults.
abstract: OBJECTIVE
  We assessed compensatory hypertrophy in the contralateral kidney after partial and radical nephrectomy in adults. We also examined predictive factors to facilitate more accurate estimation of global renal function after surgery.
  
  
  METHODS
  We analyzed the records of 172 patients who underwent partial or radical nephrectomy with appropriate studies to determine function and parenchymal mass specifically in the operated and contralateral kidneys. All patients required renal scans to provide split renal function preoperatively and postoperatively. Parenchymal volume was measured by computerized tomography. All studies were done less than 2 months preoperatively and 4 to 12 months postoperatively.
  
  
  RESULTS
  A total of 113 and 59 patients underwent partial and radical nephrectomy, and median tumor size was 3.5 and 7.0 cm, respectively (p <0.0001). Of patients treated with partial nephrectomy 19% had high complexity tumor compared to 80% of those treated with radical nephrectomy (p <0.0001). Median ipsilateral parenchymal volume was reduced 18% after partial nephrectomy and the median glomerular filtration rate in this kidney decreased 24.4%. The median contralateral kidney function increase after partial nephrectomy was 2.3% vs 21.1% after radical nephrectomy (p <0.0001). Median global function decreased 9.6% after partial nephrectomy vs 32.2% after radical nephrectomy (p <0.0001). A larger percent parenchymal volume loss (p = 0.0001) and fewer comorbidities (p = 0.0072) significantly correlated with greater compensatory hypertrophy in the contralateral kidney on multivariable analysis.
  
  
  CONCLUSIONS
  Compensatory hypertrophy in adults was limited after partial nephrectomy and it correlated significantly with the amount of parenchymal volume excised. Healthier patients also appeared to respond better. These results may allow for more accurate estimation of global renal function after partial and radical nephrectomy.
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mir
authors.affiliation: Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: Quantitative Health Service, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sevag
authors.initials: S
authors.lastname: Demirjian
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: campbes3@ccf.org.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007668:Kidney / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies
keywords: comorbidity; hypertrophy; kidney; kidney function tests; nephrectomy