title: Association of rise in C-reactive protein with decline in renal function following partial nephrectomy.
abstract: BACKGROUND
  To investigate association of C-reactive protein (CRP), a marker of systemic inflammation, with renal functional decline patients undergoing partial nephrectomy (PN) for renal mass.
  
  
  METHODS
  Retrospective study of patients who underwent PN between February 2006-March 2011, with ≥ 6 months follow up. Data was analyzed between two groups: CRP increase ≥ 0.5 mg/L from 6 months postoperative ('CRP rise,' CRPR), versus no CRP increase = 0.5 ('CRP stable,' CRPS). Primary outcome was change in estimated glomerular filtration rate (ΔeGFR, mL/min/1.73 m²), with de novo postoperative stage III chronic kidney disease (stage III-CKD, eGFR < 60 mL/min/1.73 m²) being secondary. Multivariable analysis (MVA) was conducted to identify risk factors for development of de novo stage III-CKD.
  
  
  RESULTS
  A total of 243 patients (206 CRPS/37 CRPR) were analyzed. Demographics and R.E.N.A.L. nephrometry scores were similar. CRPR had significantly higher median ΔeGFR (-13.7 versus -32.0 mL/min/1.73 m², p < 0.001) and de novo stage III-CKD at last follow up (43.2% vs. 3.7%, p < 0.001). Median time to CRP rise was 10 (IQR 6.5-12) months. Median time from CRP rise to de novo stage III-CKD was 9 (IQR 7.5-11) months. MVA found RENAL score (OR 1.89, p = 0.001), hypertension (OR 4.75, p = 0.016), and CRP rise (OR 55.76, p < 0.001) were associated with de novo stage III-CKD. Sensitivity of CRP increase ≥ 0.5 for predicting CKD was 69.6%, specificity 93.3%, positive predictive value 55.2%, and negative predictive value 96.3%.
  
  
  CONCLUSIONS
  Rise in CRP postoperatively is independently associated with renal functional decline after PN and may be useful in identifying patients to evaluate for renoprotective strategies. Further studies are requisite to clarify etiology of this association.
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, California, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Kerrin L
authors.initials: KL
authors.lastname: Palazzi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.forename: Jason
authors.initials: J
authors.lastname: Woo
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jabaji
authors.forename: Kyle
authors.initials: K
authors.lastname: Gillis
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wake
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Patterson
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein