Huang WC et al. (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7: 735–740

A retrospective study of data from patients who underwent either partial or radical nephrectomy at the Memorial Sloan–Kettering Cancer Center, between July 1989 and September 2005, has shown that radical nephrectomy is an important risk factor for new-onset chronic kidney disease (CKD), a condition associated with impaired survival and quality of life.

Huang et al. identified 662 patients who had undergone partial or radical nephrectomy for a solitary renal cortical tumor ≤4 cm. All patients had pretreatment serum creatinine levels ≤124 µmol/l, and a normal contralateral kidney. CKD was defined by a conventional glomerular filtration rate (GFR) threshold of <60 ml/min per 1.73 m2, and by a more stringent threshold of <45 ml/min per 1.73 m2. Surprisingly, the cohort had poorer baseline kidney function than expected: analysis revealed that 26% of the patients had pre-existing CKD (using the conventional GFR threshold) before surgery.

After partial nephrectomy, the 3-year probability of freedom from new-onset CKD was 80% with the conventional GFR threshold, and 95% with the more stringent threshold. After radical nephrectomy, the 3-year probability of freedom from new-onset CKD was 35% with the conventional GFR threshold, and 64% with the more stringent threshold.

Huang et al. say that radical nephrectomy is overused for patients with renal cortical tumors ≤4 cm in size. They recommend that an accurate, preoperative assessment of GFR should be an essential part of surgical decision-making for patients with these tumors.