Partial nephrectomy safely preserves renal function in patients with a solitary kidney

We examined the success of partial nephrectomy in a group of patients in whom its role is paramount, namely those with a solitary kidney requiring surgery.

We reviewed the records of 84 consecutive patients who underwent partial nephrectomy from January 1995 to August 2000. Of these 84 patients 30 (36%) met our study criteria for an absolute indication for partial nephrectomy, which included namely a solitary kidney or bilateral renal masses for which radical nephrectomy was indicated for at least 1 renal unit. The variables examined included preoperative and postoperative renal function, pathological evaluation, surgical margins, major and minor complication rates, and the need for dialysis.

At a median followup of 24 months (range 1 to 74) median creatinine had increased from 1.5 mg./dl. preoperatively to 1.8 postoperatively. None of the 30 patients required dialysis in the perioperative period. Of the tumors 22 (73%) were renal cell carcinoma and 4 (13%) were oncocytoma. All surgical margins were negative for malignancy and no patient has had local recurrence to date. Eventually but not immediately 2 patients with renal insufficiency preoperatively had progression to end stage renal disease, necessitating dialysis at long-term followup.

In patients who require partial nephrectomy this procedure can safely preserve renal function and effectively treat malignancy.