Renal function decline after radical nephroureterectomy: Longitudinal analysis and predictive factors in upper tract...

To evaluate renal function trends following radical nephroureterectomy (RNU) and identify key preoperative predictors of post-RNU renal function in patients with upper tract urothelial carcinoma (UTUC).

This retrospective study analyzed 338 UTUC patients who underwent RNU between 2008 and 2022. Estimated glomerular filtration rate (eGFR) was measured preoperatively and at <3, 3-12, and 12-24 months postoperatively. Generalized linear models assessed renal function changes over time, while generalized estimating equation (GEE) models identified predictors of postoperative eGFR.

A significant eGFR decline was observed (P < 0.001), most pronounced within three months after surgery. CKD prevalence increased from 63.91 % preoperatively to 79.29 % postoperatively. Multivariable analysis identified preoperative eGFR (β = 0.612, P < 0.001) and tumor size (β = 1.189, P < 0.001) as the strongest independent predictors of postoperative renal function, with preoperative eGFR explaining the largest proportion of variance (R² = 47.50 %). Pathological T stage and Charlson Comorbidity Index were also statistically significant.

RNU significantly and adversely affects postoperative renal function in patients with UTUC. Preoperative eGFR and tumor size are the most influential predictors of postoperative renal function. The identified predictors may assist clinicians in anticipating postoperative renal outcomes, thereby informing surgical decision-making and preoperative counseling aimed at balancing oncological control and renal preservation.