title: The percentage of resected and ischemic volume determined by a geometric model is a significant predictor of renal functional change after partial nephrectomy.
abstract: OBJECTIVE
  The percentage of parenchyma preserved plays a predominant role in predicting renal function after partial nephrectomy (PN). Currently there is no standard method to estimate preserved renal parenchyma. In this study we propose a formula of the percentage of resected and ischemic volume (PRAIV) determined by a geometric model and evaluate the relationships between renal functional change and PRAIV as well as other clinical parameters.
  
  
  METHODS
  We identified 71 patients who underwent open PN between January 2004 and April 2014. Assuming the kidney to be an ellipsoid with bilaterally equal volume and tumor to be a sphere, we calculated PRAIV by integral calculus. Nadir estimated glomerular filtration rate (eGFR) between postoperative 3 and 12 months were recorded. The correlation between percent eGFR reduction, PRAIV, and other clinical parameters were examined.
  
  
  RESULTS
  On univariate analysis, age (p=0.03), depth of tumor invasion (p=0.004), C index (p=0.003), RAIV (p=0.04), and PRAIV (p<0.001) were correlated with percent reduction of eGFR. However, only age (p=0.007) and PRAIV (p<0.001) were significantly correlated with percent reduction of eGFR on multivariate analysis. Depicting these values along the regression line, we found R2 was 0.194 and 0.073 for PRAIV and age, respectively.
  
  
  CONCLUSIONS
  PRAIV determined by a geometric model is a significant predictor of renal functional change after PN. Using PRAIV, we can estimate percent eGFR reduction preoperatively for better patient consultation and surgical planning.
authors.affiliation: Department of Urology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wei-Hsuan
authors.initials: WH
authors.lastname: Huang
authors.affiliation: Department of Urology, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Urology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Ping
authors.initials: CP
authors.lastname: Huang
authors.affiliation: Department of Urology, An-Nan Hospital, Tainan, Taiwan.
authors.forename: Hsi-Chin
authors.initials: HC
authors.lastname: Wu
authors.affiliation: Department of Urology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Po-Fan
authors.initials: PF
authors.lastname: Hsieh I
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D050377:Cold Ischemia / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D011184:Postoperative Period; D011277:Pregnanediones; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012737:Sex Factors; D047368:Tumor Burden
chemical_list: D011277:Pregnanediones; C084598:hydroxydione
keywords: Delayed Graft Function; Kidney Neoplasms; Nephrectomy 