Longitudinal change in renal function after nephroureterectomy in patients with upper tract urothelial carcinoma

Abstract

Aims: Chronic kidney disease is a significant risk factor for several comorbidities and death. The longitudinal change in renal function after nephroureterectomy in patients with upper tract urothelial carcinomas and the risk of developing chronic kidney disease (CKD) was investigated. Materials and methods: This retrospective study included 186 patients who underwent unilateral nephroureterectomy between 1997 and 2001. Creatinine data prior to and after the surgery were collected and the estimated Glomerular Filtration Rate (eGFR) were calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: The cohort of 186 patients included 87 men and 99 women with a mean age of 67.2 years. Preoperative mean eGFR was 41.97 mL/minute/1.73 m2. Eighty six percent of the patients' preoperative eGFR were <60 mL/minute/1.73 m2. The mean eGFR was 35.85 mL/minute/1.73 m2 at the end of the 5-year follow up. For the 26 patients with preoperative normal renal function, 17 patients (65.4%) had new chronic kidney diseases. Ten patients (5.4%) required hemodialysis at the end of the study. Conclusion: In this study, it was found that the average renal function of the patients with upper tract urothelial carcinoma is not as good as the general population. More than half of the normal renal function patients have new onset chronic kidney disease after surgery. For preventing further deterioration of renal function, the implication of partial nephrectomy or segmental ureterectomy for selected patients with localized urothelial carcinoma should be re-examined. Besides, neoadjuvant chemotherapy should be considered for those who are not good candidates for local treatment.

Keywords

• chronic kidney disease
• chronic renal insufficiency
• nephroureterectomy
• renal function
• urothelial carcinoma