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Renal function recovery after radical nephroureterectomy for upper tract urothelial carcinoma

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Abstract

Purpose

To understand the longitudinal renal function trends in patients undergoing radical nephroureterectomy (RNU) and identify clinicopathologic characteristics associated with estimated glomerular filtration rate (eGFR) recovery.

Methods

147 patients were available for analysis. Longitudinal eGFR trends were assessed by plotting each patient’s eGFR measurements over time. The patient population was dichotomized using eGFR < 60 ml/min/1.73 m2 versus ≥ 60 ml/min/1.73 m2. Cumulative incidence and competing risk regression analysis were used to estimate recovery of postoperative eGFR to the preoperative level and identify clinicopathologic characteristics associated with eGFR recovery.

Results

Median age was 68.7 years and median preoperative eGFR was 55.9 ml/min/1.73 m2. 63.6% were male and 95.8% were white. The cumulative incidence of eGFR recovery was significantly higher in patients with baseline eGFR < 60 ml/min/1.73 m2 compared to those with baseline eGFR ≥ 60 ml/min/1.73 m2 (p = 0.01), with recovery rates at 2 years of 56.6% vs. 27.7%, respectively. Multivariable analysis revealed that preoperative hydronephrosis (HR 1.80) and preoperative eGFR < 60 ml/min/1.73 m2 (HR 1.87) were associated with increased chance of eGFR recovery.

Conclusion

Over half of patients with preoperative eGFR < 60 ml/min/1.73 m2 achieved eGFR recovery within the first 3 years after RNU, and hydronephrosis was a significant predictor of recovery. These findings should be considered when counseling patients regarding chronic kidney disease progression after RNU and timing of perioperative chemotherapy for high risk tumors.

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Authors and Affiliations

  1. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Byron H. Lee, Daniel Tennenbaum, Nicole Benfante, Jonathan A. Coleman & Paul Russo

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Emily C. Zabor & Helena Furberg

  3. Department of Medicine, Renal Service at Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Edgar A. Jaimes

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  1. Byron H. Lee
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  2. Emily C. Zabor
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Correspondence to Paul Russo.

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Lee, B.H., Zabor, E.C., Tennenbaum, D. et al. Renal function recovery after radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 36, 257–263 (2018). https://doi.org/10.1007/s00345-017-2139-9

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  • DOI: https://doi.org/10.1007/s00345-017-2139-9

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