Impact of radical nephrectomy on renal functional outcome in patients with no other co-morbidity as determined by 24-h urinary creatinine clearance
Introduction: Renal cell carcinoma (RCC) accounts for 3% of all adult tumors. The mainstay of treatment of RCCs in the past has remained radical nephrectomy (RN). Studies have found a higher cumulative incidence of development of chronic renal insufficiency in patients undergoing RN for RCC.
Objectives: To determine the frequency of decrease in 24-h urinary creatinine clearance (CrCl) as an indicator of functional decline after nephrectomy for RCC.
Subjects and methods: A total of 103 patients of RCC undergoing RN were included in the study. Patients’ 24-h urinary CrCls were measured pre-nephrectomy and 3 months post-nephrectomy. The patients’ demographic and tumor characteristics were noted from case files. Data was analyzed by using SPSS version 15.0.
Results: There were 61 (59.2%) males and 42 (40.8%) females with a mean age of 60.12 ± 8.88 years. The mean maximum tumor diameter was 8.5 ± 2.6 cm. The mean preoperative serum creatinine in the study group was 1.01 ± 0.24 mg/dl, while the mean 3-month postoperative serum creatinine was 1.29 ± 0.46 mg/dl. The mean preoperative CrCl measured in this study was 112.02 ± 6.04 ml/min/1.73 m2, while the 3-month postoperative value was 102.94 ± 14.10 ml/min/1.73 m2, a mean decrease of 9.08 ml/min/1.73 m2. The decrease in CrCl was identified in 34 (33%) patients. No association was found between the measured functional decline and the patients’ age and gender and stage of the disease.
Conclusion: The results from this study show that RN is associated with a decrease in CrCl in one third of the study population. Therefore it is recommended that patients undergoing RN should be strictly monitored for occult renal failure and managed promptly to prevent serious morbidity of frank renal failure.