title: Association of Urine Dipstick Proteinuria and Postoperative Renal Function Following Robotic Partial Nephrectomy.
abstract: In patients with normal estimated renal function before robot-assisted partial nephrectomy (RPN), there is still a risk for de Novo chronic kidney disease (CKD). We assessed the role of dipstick spot proteinuria in risk stratifying patients for CKD progression.
  
  
  
  From our prospectively maintained, institutional review board-approved database of patients undergoing RPN, we queried those with estimated glomerular filtration rate (eGFR) >60 and bilateral functional units. We assessed proteinuria through dipstick (trace or above) on voided urine in preoperative urologic appointment <3 weeks before RPN. Proteinuric patients were compared with the remainder of the cohort with parametric comparisons for continuous and chi-squared analysis for categoric variables. Multivariate logistic regression analyses were performed assessing the risk of de Novo CKD stage III development, estimated by the CKD-EPI equation.
  
  
  
  We found 269 patients with eGFR >60 preoperatively, of whom 57 (21%) had proteinuria preoperatively. In univariate analysis, these patients were more likely to be diabetic (p = 0.023) and to be on an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (p = 0.001) but had similar age (p = 0.13), body mass index (p = 0.09), and tumor size (p = 0.56) with similar rates of hypertension (p = 0.07). At a median 16 months, controlling for confounding variables, preoperative proteinuria on urinary dipstick was associated with a 2.3× (95% confidence interval 1.03-4.95) increased risk of de Novo CKD stage III progression.
  
  
  
  Patients with proteinuria preoperatively, despite a normal eGFR, likely have intrinsic medicorenal disease. These patients should be counseled preoperatively that they have a higher risk of CKD progression following RPN.
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Heavner
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: Charles
authors.initials: C
authors.lastname: Peyton
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: James T
authors.initials: JT
authors.lastname: Rague
authors.affiliation: Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011184:Postoperative Period; D011507:Proteinuria / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D065287:Robotic Surgical Procedures; D012371:Robotics; D016896:Treatment Outcome