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  • Review Article
  • Published:

Risk of chronic kidney disease after cancer nephrectomy

Nature Reviews Nephrology volume 10, pages 135–145 (2014)Cite this article

Subjects

Key Points

  • Partial nephrectomy preserves renal function in the long term and is currently the preferred standard of care for small renal cell carcinomas (RCCs)

  • Evidence for a beneficial effect of nephron-sparing approaches versus radical nephrectomy for RCC on long-term chronic kidney disease (CKD)-associated morbidity and overall survival is inconclusive and controversial

  • The quantity and integrity of the preserved renal parenchyma after nephrectomy are important predictors of long-term renal outcomes

  • Renal tumours and CKD share intrinsic kidney risk factors and systemic comorbidities and a bi-directional relationship between RCC and CKD has been proposed

  • Further research is needed to quantify the perioperative risks and potential long-term benefits of nephron-sparing surgery for RCC

  • A prediction model to identify patients at risk of oncological and nononcological morbidity and mortality after nephrectomy would help personalize the management of patients with small RCCs

Abstract

The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours. Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management.

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Figure 1: Potential pathophysiology of de novo CKD and progression of pre-existing CKD after kidney tumour nephrectomy.
Figure 2: Potential bidirectional relationship between RCC and CKD.
Figure 3: Hypothetical causal models for the association between cancer nephrectomy for RCC and increased risk of CKD.

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Acknowledgements

K. Kalantar-Zadeh's work is supported in part by NIH grants K24-DK091419, R01-DK078106, R01-DK095668, R01-DK096920, and R13-DK094686 2011 and by a philanthropist grant from Mr Harold Simmons. W. L. Lau's work is supported by a Sanofi fellowship award. C. M. Rhee's work is supported by NIH/NIDDK grant F32 DK093201.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, University of California, Irvine, 101 The City Drive South, Orange, 92868, CA, USA

    Lin Li, Wei Ling Lau, Connie M. Rhee, Kevin Harley & Kamyar Kalantar-Zadeh

  2. Division of Nephrology, University of Tennessee Health Science Centre, 956 Court Avenue, Memphis, 38163, TN, USA

    Csaba P. Kovesdy

  3. Department of Research, Kaiser Permanente of Southern California, 4700 Sunset Boulevard, Pasadena, 90027, CA, USA

    John J. Sim

  4. Department of Research, Kaiser Permanente of Southern California, 100 S. Los Robles, Pasadena, 91101, CA, USA

    Steve Jacobsen

  5. Department of Pathology, University of Chicago, 5841 S. Maryland Avenue, Chicago, 60637, IL, USA

    Anthony Chang

  6. Department of Urology, University of California, Irvine, 333 The City Drive South, Orange, 92868, CA, USA

    Jaime Landman

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Contributions

L. Li and K. Kalantar-Zadeh researched the data for the article. L. Li, W. L. Lau, and K. Kalantar-Zadeh made a substantial contribution to discussion of the content. L. Li, W. L. Lau, K. Harley, C. P. Kovesdy, S. Jacobsen, A. Chang, and K. Kalantar-Zadeh wrote the article and L. Li, W. L. Lau, C. M. Rhee, C. P. Kovesdy, J. J. Sim, S. Jacobsen, A. Chang, J. Landman, and K. Kalantar-Zadeh reviewed and edited the manuscript prior to submission.

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Correspondence to Kamyar Kalantar-Zadeh.

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Competing interests

K. Kalantar-Zadeh has received honoraria and/or research grants from Abbott, DaVita, Fresenius, Genzyme, and Shire. The other authors declare no competing interests.

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Li, L., Lau, W., Rhee, C. et al. Risk of chronic kidney disease after cancer nephrectomy. Nat Rev Nephrol 10, 135–145 (2014). https://doi.org/10.1038/nrneph.2013.273

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