New Baseline Renal Function after Nephrectomy
From the time PN became the method of choice wherever or whenever possible for RCC, considerable studies have been generated on how to evaluate the postop outcomes of both PN and RN, preoperatively. Renal Insufficiency following PN/RN has been Challenging to predict but is important in Surgical planning and Counselling.
There are several Published Models comparing how to Predict Functional Outcomes after PN or RN.
I am providing a list of such studies available in the article of Diego Aguilar Palacios* et al (2021, J Urology, 205 (5 May): 1310) (PDF provided).
The primary objective of this study was to develop a simple and accurate predictive model for estimating the new baseline glomerular filtration rate (NB-GFR) after partial nephrectomy (PN) or radical nephrectomy (RN). Previous studies have shown that a threshold of NB-GFR after surgery of about 45 mL/min/1.73 m2 has implications with respect to long-term survival. The AUA guidelines now recommend consideration for RN whenever increased oncologic potential is suspected based on tumour size, renal mass biopsy (if obtained), or imaging features. In this setting, RN is preferred if all of the following criteria are also met: 1) high tumour complexity; 2) no preexisting CKD/proteinuria; and 3) a normal contralateral kidney that will likely provide NB-GFR >45 mL/min/1.73 m2 even if RN is performed. The study provides an equation to predict NB-GFR that is based on preoperative GFR, the procedure performed (PN or RN), age, tumour size, and the presence/absence of diabetes. The performance characteristics are strong, with a correlation index of 0.82, and the data are validated in an independent cohort. Furthermore, the area under the curve for prediction of an NB-GFR threshold of 45 mL/min/1.73 m2 was also encouraging (0.90).
This Formula was New baseline GFR = 35 + Preop GFR (x 0.65) â€“ 18 (if Radical Nephrectomy) â€“ Age (x 0.25) + 3 (if Tumour Size >7cm) â€“ 2 (if Diabetic).
The ROC Curve that evaluated the ability of the equation to discriminate Postop GFR 45mL/minute/1.73m2 were 0.90 for both Internal and external validation sets.
This new Predictive Model introduced which has been Internally and Externally validated could provide us a more accurate prediction for planning surgical options and Post op outcomes Preoperatively. Is it time for us to change to this new proposal?
With warm Regards,