The Journal of Urology

Volume 192, Issue 4, Pages 1057-1063 (October 2014)

DOI: 10.1016/j.juro.2014.04.016

Presented by

Dr. Shanty Fernandez

 Abstract
• CKD is a risk factor for progression to end stage renal
disease. Patients undergoing partial or radical
nephrectomy for renal cancer experience perioperative
nephron loss, which may result in de novo CKD.

• In addition, the process leading to loss of functioning

renal mass (surgical vs medical) may further modify the
trajectory of CKD progression in these patients.
 Purpose
• CKD is associated with a higher likehood of progression
to end stage renal disease and increased mortality rates.

• However, the etiology of nephron loss may modify the

rate of CKD progression and overall survival.
 Material and Methods
• Patients with suspected renal malignancy who had a
new baseline glomerular filtration rate of less than 60
ml/minute/1,73 m2 6 weeks after surgery were divided
into the 2 groups of
 Groups
CKD-S CKD-M/S CKD-M
(surgically induced CKD) (CKD due to medical (CKD due to medical
comorbidities followed by comorbidities)
surgical removal of nephron

Variable
Demographi Renal
Comorbidities
cs Parameter
(HTN, DM, heart
(age, Gender, (eGFR,
race) disease)
Proteinuria)
Result
 Table 1. Demographics and baseline characteristics grouped by etiology of kidney disease

MEDICAL MEDICAL/SURGICAL SURGICAL

Mean SD pt age 73 ± 12 69 ± 11 63 ± 11
No. Male (%) 19.004 712 (68) 737 (67)
No. African- 5.134 64 (6) 64 (6)
American (%)
No. With diabetes 9.031 177 (17) 132 (132)
(%)
No with 34.678 561 (53) 472 (43)
hypertension (%)
No. Wuth 3.295 45 (4) 15 (1)
congestive heart
failure (%)
Mean SD baseline 47 ± 10 45 ± 10 77 ± 12
eGFR
No./total No. 6.625/26.618 (25) 85/269 (32) 38/243 (16)
Baseline proteinuria
(%)
Mean SD new 47 ± 10 37 ± 11 48 ± 9
baseline eGFR
 Table 2. Outcome grouped by Etiology of CKD

No./Total No. (%)

Medical Medical/surgical Surgical

CKD Progression 2.606/33.740 (8) 62/593 (10) 24/612 (4)

Overall mortality 4.264/42.658 (10) 236/1.054 (22) 147/1.096 (13)

Probability of 50% decrease in eGFR or need for renal replacement therapy in 3 years. Probability of
reaching composite renal end point at 3 years is illustrated for each group based on new baseline eGFR
after adjusting for age, gender, race, diabetes, hypertension and heart disease (A). Analysis is also adjusted
for proteinuria (B). Curves illustrate estimates and 95% CIs at each level of new baseline eGFR.
 Conclusions

Surgically induced chronic kidney disease has a

! lower rate of functional decline and less impact

on survival than chronic kidney disease due to
medical causes
!
THANK YOU