title: The Utility of the Remnant Kidney Volume/Body Surface Area Ratio and Tumor Diameter as Predictors of Postoperative Degree of Renal Functional Decline in Patients With Renal Cell Carcinoma Treated by Radical Nephrectomy.
abstract: OBJECTIVE
  To characterize the preoperative factors affecting renal cell carcinoma patients as predictive of post-radical nephrectomy (RN) mild (M-decline) or severe (S-decline) renal functional decline and to elucidate the histopathologic features of the resected normal kidney cortex, as well as the occurrence of cardiovascular disease (CVD) in both M-decline and S-decline patients.
  
  
  METHODS
  M-decline and S-decline were categorized as a percentage of postoperative estimated glomerular filtration rate decline of <20 and of >40, respectively. The preoperative factors analyzed were patient demographics, comorbidities, and radiographic findings, including remnant kidney status and tumor size. The factors based on postoperative information analyzed were tumor and normal cortex pathology and CVD events.
  
  
  RESULTS
  In 175 patient cohort, 21 and 32 cases were categorized as M-decline and S-decline, respectively. Absence of comorbidities, larger remnant kidney volume (RKV)/body surface area (BSA) ratio, and larger tumor diameter were significantly predictive of M-decline, whereas smaller tumor diameter was significantly predictive of S-decline. The global glomerulosclerosis extent in nephrectomized normal cortex of S-decline cases was significantly higher than in other types of cases. No CVD event was observed in M-decline cases.
  
  
  CONCLUSIONS
  This is the first report to identify the RKV/BSA ratio as a promising predictor of post-RN degree of renal functional decline. Post-RN prevention of life-threatening outcomes according to preoperative and postoperative information, including the degree of post-RN renal functional decline and histopathology of the nephrectomized normal cortex, should be considerable in future urological tasks.
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. Electronic address: sejimat@grape.med.tottori-u.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Yamaguchi
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ono
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Koumi
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Honda
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
mesh_terms: D001830:Body Surface Area; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000503:physiopathology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D047368:Tumor Burden