Functional Adaptive Hyperfiltration May Affect Renal Function after Radical Nephrectomy

Overall, the researchers found that the classification of patients according to stages of CKD based on their preoperative GFR indicated that functional hyperfiltration estimated by the GFR per unit volume was significantly changed. However, the structural hypertrophic volume did not differ.

“The study essentially found that while all patients who lose a kidney lose function those with reduced function at baseline (CKD 2 and 3) lost proportionally less function than those with normal function at baseline. Also, the reason they lost less function was not due to growth of the remaining kidney, but greater functional recovery,” said Yair Lotan, MD, who is Professor of Urology and Chief of Urologic Oncology at the University of Texas Southwestern Medical Center in Dallas, TX.

“I don’t think that this will lead to new ways to recover function after nephrectomy. However, if this single center retrospective study is validated then maybe there can be better ways to estimate final renal function after nephrectomy,” Dr. Lotan told Cancer Therapy Advisor.

“This is important in advising patients whether to have their kidney removed in case of cancer and whether they will be eligible for certain chemotherapy regimens which contain nephrotoxic drugs.”

Matthew J. Resnick, MD, MPH, Assistant Professor of Urologic Surgery and Health Policy Center for Surgical Quality and Outcomes Research at Vanderbilt University Medical Center in Nashville, TN, said these new data begin to shed some light on possible mechanisms for differential preservation of renal function after loss in renal volume. He said the findings may have many important clinical implications.

“Given the paramount importance of postoperative renal function with respect to risk of cardiovascular disease and death, these data may improve predictions of postoperative renal function to facilitate improvement in preoperative counseling. Additionally, and perhaps more importantly, further characterization of the mechanism underlying hyperfiltration may identify therapeutic targets aimed at optimizing renal function outcomes in patients undergoing surgery for renal cell carcinoma,” Dr. Resnick told Cancer Therapy Advisor.

Reference

1. Choi DK, Jung SB, Park BH, et al. Compensatory Structural and Functional Adaptation after Radical Nephrectomy for Renal Cell Carcinoma according to the Preoperative Stage of Chronic Kidney Disease. J Urol. April 27, 2015. [Epub ahead of print] doi: 10.1016/j.juro.2015.04.093.