Comparison of radical and partial nephrectomy in terms of renal function: a retrospective cohort study

This study aimed to evaluate kidney function following radical or partial nephrectomy and to evaluate the role of two common chronic diseases, hypertension (HT) and diabetes mellitus (DM), on glomerular filtration rate (GFR) in the long term.

Data on 488 patients who underwent surgery for renal tumours between 1994 and 2008 were investigated. Patient characteristics and estimated GFR, history of DM or HT, tumour size and new-onset decrease in GFR were recorded. Multivariable Cox proportional hazards regression was used to investigate whether the two types of operation were associated with chronic kidney failure after surgery, and the outcome was adjusted for age, gender, HT, DM and tumour size. p Values less than 0.05 was regarded as significant.

Seventeen patients (18.9%) in group 1 and 176 (68%) in group 2 developed new onset of GFR < 60 ml/min/1.73 m(2). Three patients (2.9%) in group 1 and 137 (37.2%) in group 2 developed new onset of GFR < 45 ml/min/1.73 m(2) (p < 0.05). HT was associated with new-onset chronic renal failure in the radical nephrectomy group (hazard ratio 1.39, 95% confidence interval 1.028-1.890).

After surgical treatment of renal masses, patients are at risk for development of chronic renal failure. A decrease in GFR was detected in both partial and radical nephrectomy, the latter associated with increased risk, especially in hypertensive patients. Routine praxis of radical nephrectomy should be overviewed.