Pd43-03 functional recovery after partial nephrectomy in a solitary kidney

You have accessJournal of UrologyCME1 Apr 2023PD43-03 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Worapat Attawettayanon, Yosuke Yasuda, JJ Zhang, Nityam Rathi, Carlos Munoz-Lopez, Kieran Lewis, Ben Ponvilawan, Snehi Sha, Jianbo Li, Joao Accioly, Rebecca Campbell, Joseph Zabell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Christopher Weight, and Steven Campbell Worapat AttawettayanonWorapat Attawettayanon More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , JJ ZhangJJ Zhang More articles by this author , Nityam RathiNityam Rathi More articles by this author , Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Kieran LewisKieran Lewis More articles by this author , Ben PonvilawanBen Ponvilawan More articles by this author , Snehi ShaSnehi Sha More articles by this author , Jianbo LiJianbo Li More articles by this author , Joao AcciolyJoao Accioly More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Joseph ZabellJoseph Zabell More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Mohamad EltemamyMohamad Eltemamy More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Christopher WeightChristopher Weight More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the reference standard for management of renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain ill-defined. METHODS: 841 RMSK patients (1975-2022) managed with PN with functional data were identified, including 361/435/45 with cold/warm/zero ischemia, respectively. 155 patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery from ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Multivariable analysis was utilized to identify predictive factors for AKI and Rec-Ischemia. RESULTS: Overall, median preoperative GFR was 56.7ml/min/1.73m2 and median new baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, median warm (n=70)/cold(n=85) ischemia times were 25/34 minutes, respectively, and median preoperative, new baseline and 5-year GFRs were 57.8, 45.0 and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r=0.84, p<0.001). Loss of parenchymal volume accounted for 69% of the total median GFR decline associated with PN, leaving only an average of 3-4 ml/min/1.73m2 due to ischemia and other factors. AKI occurred in 52% of patients and was Grade 2/3 in 20%. The only independent predictor of AKI was ischemia time, and independent predictors of Rec-Ischemia were age, warm ischemia, and AKI grade. CONCLUSIONS: The main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type and duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of vascularized parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1118 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Worapat Attawettayanon More articles by this author Yosuke Yasuda More articles by this author JJ Zhang More articles by this author Nityam Rathi More articles by this author Carlos Munoz-Lopez More articles by this author Kieran Lewis More articles by this author Ben Ponvilawan More articles by this author Snehi Sha More articles by this author Jianbo Li More articles by this author Joao Accioly More articles by this author Rebecca Campbell More articles by this author Joseph Zabell More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Mohamad Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Christopher Weight More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...