Preoperative proteinuria correlates with renal function after partial nephrectomy for renal cell carcinoma

Area of Science:

• Nephrology
• Urology
• Oncology

Background:

• Preoperative proteinuria is a known prognostic factor for chronic kidney disease (CKD).
• Assessing renal function post-partial nephrectomy (PN) is crucial for patient outcomes.
• Understanding predictors of renal function deterioration after PN is important for surgical planning and patient management.

Purpose of the Study:

• To evaluate the association between preoperative proteinuria and renal function following partial nephrectomy (PN).
• To identify predictors of short-term and long-term renal function after PN in patients with malignant renal masses.

Main Methods:

• Retrospective review of patients who underwent PN for a single malignant renal mass between 2000 and 2021.
• Inclusion of patients with available preoperative proteinuria data.
• Analysis of baseline characteristics, estimated glomerular filtration rate (eGFR) changes, and logistic regression models to predict CKD stage III or higher at 12 months and last follow-up.

Main Results:

• Two hundred ninety-five patients were included; 22 had preoperative proteinuria.
• No significant differences were observed in age, smoking status, hypertension, diabetes, tumor size, or use of ischemia between groups.
• Patients with proteinuria had a higher rate of baseline CKD-III. At a median follow-up of 46.5 months, no differences in de novo CKD-III or eGFR decline were observed between groups.
• Univariate analysis identified preoperative proteinuria, age, and baseline eGFR as predictors of CKD-III at 12 months. Age and baseline eGFR predicted CKD-III at last follow-up.
• Multivariable logistic regression analysis revealed baseline eGFR as the only independent predictor of CKD-III at both 12 months and last follow-up.

Conclusions:

• Baseline eGFR is the sole independent predictor of long-term renal function after PN.
• Preoperative proteinuria correlates with renal function at 12 months post-PN.
• Proteinuria assessment before PN can help identify patients at higher risk for renal functional deterioration within the first year.