PD16-10 OBJECTIVE ASSESSMENT OF PRESERVATION OF GFR AFTER ROBOTIC PARTIAL NEPHRECTOMY USING MERCAPTO-ACETYLTRIGLYCINE (MAG 3) RENAL SCAN

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You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2014PD16-10 OBJECTIVE ASSESSMENT OF PRESERVATION OF GFR AFTER ROBOTIC PARTIAL NEPHRECTOMY USING MERCAPTO-ACETYLTRIGLYCINE (MAG 3) RENAL SCAN Homayoun Zargar, Oktay Akca, Riccardo Autorino, Luis Felipe Brandao, Laydner Humberto, Jayram Krishnan, Dinesh Samarasekera, Robert Stein, and Jihad H. Kaouk Homayoun ZargarHomayoun Zargar More articles by this author , Oktay AkcaOktay Akca More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Luis Felipe BrandaoLuis Felipe Brandao More articles by this author , Laydner HumbertoLaydner Humberto More articles by this author , Jayram KrishnanJayram Krishnan More articles by this author , Dinesh SamarasekeraDinesh Samarasekera More articles by this author , Robert SteinRobert Stein More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1155AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Our aim was to assess degree of renal function preservation and factors influencing it after robotic partial nephrectomy Methods Our inclusion criteria encompassed patients undergoing RPN at our centre who had completed pre-operative and post-operative MAG3 renal scan. Glomerular filtration rate (eGFR) was calculated by using the modification of diet in renal disease formula. Based on eGFR patients were assigned chronic kidney disease stage, pre and post-operatively (CKD 1-5). The eGFR for each operated kidney was calculated by multiplying the percentage of contribution of that kidney obtained from renal scan by total eGFR at the time of renal scan. Percentage of affected kidney (PaGFRP) eGFR preservation was defined as a ratio of post-op eGFR for the operated kidney to pre-op eGFR for the operated kidney. Percentage of total eGFR preservation (PtGFRP) was calculated in the same manner (post-op eGFR/Pre-op eGFR). We calculated the amount of renal parenchyma surrounding the tumor, by deducting the volume of tumour (calculated by exact CT volume measurement) from the volume of partial nephrectomy specimen on pathology (calculated by ellipsoid formula from pathological measurements). Univariable and multivariable analysis were used to define factors affecting the PGFRP. Results Records of 680 RPN were examined and 99 patients met our inclusion criteria. The median time to post-op renal scan and latest GFR were 61 and 201 days respectively. The mean PaGFRP and PtGFRP were 72.6±21.3 and 84.6±17 respectively .18 (18.2%) patients upstaged their CKD status. 58 (58.6%) maintained 80% or more of the total pre-op eGFR. On univariable analysis WIT, and tumor size were associated with PaGFRP in the operated kidney (p<0.05). On multivariable analysis pre-operative GFR and the amount of surrounding renal parenchyma resection at the time of surgery were significant factors predicting the percentage of function from the operated kidney. Conclusions Robotic partial nephrectomy was associated with more than 70% preservation of function in the operated kidney and 80% of the total eGFR in our series. Amount of normal renal parenchymal removal at the time of tumor resection, is an independent factor in predicting the percentage of eGFR preservation in the affected kidney. Factors predicting %GFR preservation in the operated kidney Effect Size 95.0% Confidence Interval for effect size p Tumor Volume(cc) 0.08 (-0.05,0.22) 0.21 Pre-op eGFR -0.20 (-0.39,-0.008) 0.042 RENAL Score -0.72 (-3.4,1.98) 0.60 WIT > 20 min -11.3 (-23.08,0.48) 0.06 Renal parenchyma removed(per 10cc) -1.05 (-2.09,-0.003) 0.049 WIT:warm ischemic time; eGFR estimated glomerular function rate © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e490-e491 Advertisement Copyright & Permissions© 2014Metrics Author Information Homayoun Zargar Mor