title: Impact of partial nephrectomy on kidney function in patients with renal cell carcinoma.
abstract: BACKGROUND
  This study aimed to compare the changes in kidney function and the association of tumor size and renal outcomes between patients with renal cell carcinoma (RCC) who underwent radical nephrectomy (RN) and those who underwent partial nephrectomy (PN).
  
  
  METHODS
  A retrospective cohort study was conducted for 557 patients with an RCC of ≤7 cm in diameter and normal contralateral kidney function who underwent PN or RN. PN was performed for 218 (39%) patients. Renal outcomes included the incidence of acute kidney injury (AKI), new-onset chronic kidney disease (CKD), and a ≥25% decline in eGFR 1 year after surgery.
  
  
  RESULTS
  Serial changes in eGFR were compared during the 3 years of follow-up. Postoperative eGFR was significantly lower in patients undergoing RN than in those undergoing PN. The incidence of AKI and new-onset CKD was significantly higher in patients after RN (70.1% vs. 24.3%, respectively; P<0.001) than after PN (55.7% vs. 6.2%, respectively; P<0.001). According to the multivariable logistic regression analysis, RN was an independent risk factor for a ≥25% decline in kidney function after 1 year regardless of the tumor size, even after adjusting for various covariates.
  
  
  CONCLUSIONS
  Compared to PN, RN for even a moderate sized RCC leads to an increased incidence of AKI and new-onset CKD, and is a significant risk factor for kidney function decline. Therefore, PN should be considered as the choice of surgical treatment for RCCs that are ≤7 cm in diameter in order to preserve renal function postoperatively.
authors.forename: Chang Seong
authors.initials: CS
authors.lastname: Kim
authors.forename: Eun Hui
authors.initials: EH
authors.lastname: Bae
authors.forename: Seong Kwon
authors.initials: SK
authors.lastname: Ma
authors.forename: Sun-Seog
authors.initials: SS
authors.lastname: Kweon
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 501-757, Korea. skimw@chonnam.ac.kr.
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden