Surgery for renal masses increases the risk of AKI, clinically significant CKD

According to researchers, renal-preserving patients undergoing surgery for localized renal masses (cT1-T2N0M0) are at increased risk of acute kidney injury (AKI) and clinically significant chronic kidney disease (CKD). , especially in the presence of highly complex tumors. Presented at the 38th Annual Meeting of the European Urological Association in Milan, Italy.

The findings are from a study of 2469 patients with localized renal masses, of whom 1063 (43%), 947 (38%), and 459 (19%) had low had medium- and high-complexity tumors. All patients had an estimated preoperative glomerular filtration rate (eGFR) of 60 mL/min/1.73 m.2 Above and normal contralateral kidney.

At discharge, 8.7%, 14%, and 31%, respectively, had AKI, reported researcher Alessio Pecoraro, MD, of the College Hospital of the University of Florence, Italy, on behalf of his team. At 60 months, his 91%, 87%, and 79% of patients in these groups had not developed clinically significant CKD, and researchers noted that his eGFR was 45 mL/ defined as less than min/1.73 m.2.

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In multivariate analysis, patients with moderate- and high-complexity tumors had significantly increased odds of AKI by 1.5-fold and 3.0-fold compared with those with low-complexity tumors. In patients with a history of hypertension, the odds of AKI he significantly increased 1.3-fold. Patients undergoing radical nephrectomy had a significant 10.2-fold increase in the odds of AKI compared with those undergoing partial nephrectomy.

Cox regression analysis showed that the age-adjusted Charlson Comorbidity Index, preoperative eGFR, tumor complexity, and radical nephrectomy significantly predicted the risk of clinically significant CKD. 10mL/min/1.73m per minute2 An increase in preoperative eGFR was associated with a 42% reduction in the risk of clinically significant CKD. There was a 1.8-fold and 2.7-fold increased risk of clinically significant CKD in moderate- and high-complexity tumors compared with low-complexity tumors, respectively. Patients who underwent radical and partial nephrectomy had a 3.9-fold increased risk of CKD.

“The risk of acute kidney injury and de novo clinically significant CKD in selected patients with localized renal masses and preserved baseline renal function is significant, especially in patients with high-complexity tumours. It cannot be ignored clinically,” Dr. Pecoraro told attendees. “Baseline immutable patient/tumor-related characteristics modulate this risk, but if oncological outcome is not jeopardized, it may be preferred over radical nephrectomy to maximize nephron preservation.” Partial nephrectomy should be prioritized.”


Pecoraro A, Roussel E, Amparore D, et al. New-onset chronic kidney disease after surgery for a focal renal mass in patients with two kidneys and preserved renal function: a modern multicenter study. Presentation location: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0341.

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