title: Retrospective analysis of the predictive factors of renal function loss after uninephrectomy in patients with chronic kidney disease G3 to G5.
abstract: BACKGROUND
  The rapid increase in glomerular filtration rate in a normal contralateral kidney after uninephrectomy is well known in living kidney donors but much less well described in chronic kidney disease (CKD). The purpose of this study is to determine the magnitude of this initial compensatory capacity in (CKD) groups 3 to 5 (G3 to G5) patients undergoing uninephrectomy and the clinical factors predicting it. This is a retrospective study of all cases (142) of uninephrectomy in patients with estimated glomerular filtration rate (eGFR; with MDRD equation) <60 ml/min/1.73 m(2), between 2003 and 2010, in two University of Montreal-affiliated teaching hospitals.
  
  
  METHODS
  Baseline eGFR, patients' comorbidities, and surgical characteristics and complications were noted. The change of eGFR after nephrectomy was evaluated; moreover, the expected post-op eGFR, i.e. without compensation by the contralateral kidney following surgery, was estimated in a sub-group of patients who had a preoperative renal scintigraphy and compared to the actual eGFR at hospital discharge.
  
  
  RESULTS
  The mean change of eGFR from baseline to hospital discharge was -5 ± 12 ml/min/1.73 m(2) (-11 %; 95 % CI -16 to -6 %; P < 0.001). In univariate and multivariate analyses, baseline eGFR did not influence significantly these results. However, in the multivariate model, radical nephrectomy vs. partial nephrectomy and preoperative hypertension predicted a worse renal outcome. In the sub-group of patients with preoperative renal scintigraphy, the actual eGFR at hospital discharge was also higher than expected from the renal split function (13 ml/min/1.73 m(2); 95 % CI 10 to 16; P < 0.001).
  
  
  CONCLUSIONS
  After uninephrectomy, the contralateral kidney in patients with CKD G3 to G5 still has a clinically significant initial compensatory capacity. The compensation is statistically smaller if the patient had hypertension or a radical uninephrectomy. This initial compensation is rapid and most probably haemodynamic (hyperfiltration). However, most of the included patients had a CKD G3, limiting the strength of the conclusion for the G4 toG5 patients; the length of observation covers the early postoperative period, i.e. less than 2 weeks, in more than half of the cohort.
authors.affiliation: Department of Medicine, CHUM Hôpital Saint-Luc, 1058 Saint-Denis, Montréal, Québec H2X 3J4 Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Dupuis
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont, 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2 M4 Canada.
authors.forename: Georges
authors.initials: G
authors.lastname: Ouellet
authors.affiliation: Department of Medicine, CHUM Hôpital Saint-Luc, 1058 Saint-Denis, Montréal, Québec H2X 3J4 Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Roy
keywords: CKD; Chronic renal failure; Hyperfiltration; Nephrectomy; Nephropathy progression