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World J Clin Urol. Mar 24, 2017; 6(1): 10-17
Published online Mar 24, 2017. doi: 10.5410/wjcu.v6.i1.10
Chronic kidney disease after radical nephrectomy for suspected renal cancers
Tuck Y Yong, Kareeann S F Khow
Tuck Y Yong, Internal Medicine, Flinders Private Hospital, Bedford Park, South Australia 5042, Australia
Kareeann S F Khow, Adelaide Geriatrics Teaching and Research with Aged Care, the University of Adelaide, Paradise, South Australia 5075, Australia
Author contributions: Yong TY and Khow KSF designed, performed the research and wrote the paper.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Tuck Y Yong, FRACP, Internal Medicine, Flinders Private Hospital, Flinders Drive, Bedford Park, South Australia 5042, Australia. tyyong@hotmail.com
Telephone: +61-8-82412121 Fax: +61-8-82400879
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: November 30, 2016
Revised: December 29, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: March 24, 2017
Abstract

Nephrectomy is the treatment of choice for early stage renal cell carcinoma. However, radical nephrectomy is consistently associated with higher rates of new-onset chronic kidney disease (CKD) than the general population, regardless of the method used in measuring renal function. The higher rates of CKD are associated with worsened survival because of increased risk of cardiovascular diseases and mortality. Comorbidities and adjacent non-neoplastic kidney diseases are important risk factors for the development of CKD after nephrectomy. Partial nephrectomy has become the standard of care for patients with stage 1a tumours (diameter < 4 cm) and an attractive option for those with stage 1b (diameter 4-7 cm). Therefore stratifying the risk of postoperative CKD before surgery is important and ongoing monitoring of kidney function after radical nephrectomy is needed in addition to oncological surveillance. More research is needed to better understand the risk of CKD after radical nephrectomy and develop effective strategies to optimize kidney function after such surgery.

Keywords: Nephrectomy, Renal function, Renal cell carcinoma, Chronic kidney disease, Prevention

Core tip: Chronic kidney disease (CKD) is an important complication associated with radical nephrectomy. CKD post-nephrectomy is associated with increased risk of cardiovascular diseases. Risk factors for CKD should be assessed thoroughly before radical nephrectomy. Where possible, nephron-sparing treatment should be used to mitigate the onset of CKD after tumour resection.