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Published on: July 18, 2025
Long-term renal functional outcomes of minimally invasive partial nephrectomy for renal cell carcinoma
Anudeep Mukkamala1, Chang He1, Alon Z Weizer1
1Department of Urology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI.
Objective:
Preservation of renal function is the major benefit of partial over radical nephrectomy. We evaluated patients undergoing minimally invasive partial nephrectomy (MIPN) to better understand factors predicting long-term renal function.
Methods:
We identified 358 patients who underwent MIPN for confirmed renal cell carcinoma between 1998 and 2011 with a serum creatinine level at least 1 year postoperatively. Exposure variables included demographic, clinical, and perioperative information. The primary outcome was clinically significant progression of chronic kidney disease (CKD) class, defined as estimated glomerular filtration rate (eGFR) decreasing from >60 to<60, from 30 to 60 to <30, or from 15 to 30 to<15. Bivariate and multivariate analyses were performed.
Results:
Median follow-up was 39 months. Only 7 patients had a solitary kidney. A total of 47 patients (13%) had CKD class progression. The estimates for remaining free of CKD class progression at 5, 7, and 10 years were 86.98%, 75.45%, and 53.54%, respectively. On multivariate analysis, lower preoperative eGFR (odds ratio [OR] = 0.97, 95% CI: 0.96-0.98), larger tumor size (OR = 1.22, 95% CI: 1.01-1.48), and longer ischemia time (OR = 1.03, 95% CI: 1.01-1.05) were associated with CKD class progression.
Conclusions:
Clinically significant progression of CKD occurs in a minority of patients 5 years after MIPN, but in almost one-half, it occurs 10 years after surgery. Lower preoperative eGFR and larger tumor size are associated with greater incidence of CKD progression. Longer ischemia time, even when most patients had 2 kidneys and when controlling for other factors, nonetheless increased the risk of CKD progression, although this may be a marker of other unmeasured variables.
Insights
Minimally invasive partial nephrectomy (MIPN) can lead to chronic kidney disease (CKD) progression in some patients. Lower preoperative kidney function and larger tumors increase this risk over time.
Area of Science:
- Nephrology
- Urology
- Oncology
Background:
- Partial nephrectomy is preferred for preserving renal function.
- Minimally invasive partial nephrectomy (MIPN) is a common approach.
- Long-term renal function after MIPN requires further understanding.
Purpose of the Study:
- To evaluate factors predicting long-term renal function after MIPN.
- To identify predictors of chronic kidney disease (CKD) progression post-MIPN.
Main Methods:
- Retrospective analysis of 358 patients undergoing MIPN for renal cell carcinoma (1998-2011).
- Primary outcome: clinically significant CKD class progression (eGFR decline).
- Multivariate analysis of demographic, clinical, and perioperative variables.
Main Results:
- 13% of patients experienced CKD class progression.
- Estimated 10-year freedom from CKD progression was 53.54%.
- Predictors of progression: lower preoperative eGFR, larger tumor size, longer ischemia time.
Conclusions:
- Clinically significant CKD progression occurs in a minority at 5 years, but nearly half by 10 years post-MIPN.
- Lower preoperative eGFR and larger tumor size are associated with increased CKD progression.
- Longer ischemia time also increases CKD progression risk, potentially indicating unmeasured factors.
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