Bone health and chronic kidney disease: another reason for partial nephrectomy?

To review the potential role of surgically induced nephron loss in calcium metabolism and its consequences on bone heath, and possible impact of surgical management of renal tumors on bone disorders.

With long-term oncological equivalence to radical nephrectomy and renal functional benefit, partial nephrectomy is the reference standard for management of clinical T1 renal tumors. Impact of nephron preservation on reduction of cardiovascular sequelae of chronic kidney disease is controversial. Reports from preclinical models provide a mechanism for surgically induced nephron loss leading to vitamin D and calcium metabolism dysregulation, resulting in osteoporosis. Emerging retrospective data also suggest that nephron preservation in setting of surgical treatment of renal malignancy may reduce risk of chronic kidney disease and sequelae, including osteoporosis and fractures. The magnitude and broader impact is unclear as other reports suggest that surgically induced chronic kidney disease is more stable than its medical counterpart.

Preclinical models and retrospective series suggest that surgically induced nephron loss is independently associated with development of osteopenia and fractures and biochemical events, which may lead to these subsequent events. Although prospective data is requisite, it is reasonable to prioritize nephron preservation when feasible in patients with preexisting disorders of bone metabolism, or to consider partial nephrectomy in patients with risk factors for osteoporosis.