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Is diameter‐axial‐polar scoring predictive of renal functional damage in patients undergoing partial nephrectomy? An evaluation using technetium T c 99m ( 99 T c m ) diethylene‐triamine‐penta‐acetic acid ( DTPA ) glomerular filtration rate
Author(s) -
Wang Linhui,
Li Mingmin,
Chen Wei,
Wu Zhenjie,
Cai Chen,
Xiang Chun,
Sheng Jing,
Liu Bing,
Yang Qing,
Sun Yinghao
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12108
Subject(s) - renal function , nephrectomy , medicine , kidney , urology , scintigraphy , technetium , nuclear medicine
Objective To identify the effects of diameter‐axial‐polar ( DAP ) scoring and other clinical variables on renal functional outcomes after partial nephrectomy ( PN ).Material and Methods A total of 59 patients with complete radiographic, clinical and follow‐up information were included for analysis. Technetium T c 99m ( 99 T c m )‐diethylene‐triamine‐penta‐acetic acid ( DTPA ) renal scintigraphy was used to determine the glomerular filtration rate ( GFR ) of both kidneys and each kidney individually. All cross‐sectional images were reviewed by a single radiologist and a DAP score was assigned.Results The median decline in total GFR after PN was 13% at a median follow‐up of 12 months (from 86.8 to 76.2 mL/min per 1.73 m 2 , P < 0.001). The median GFR of the operated kidney showed a significant decrease peri‐operatively (42.4 to 27.1 mL/min per 1.73 m 2 , P < 0.001). The function of the contralateral kidney showed a significant increase (43.5 to 48.8 mL/min per 1.73 m 2 , P < 0.001). On multivariate analysis, preoperative total GFR , ischaemia time and DAP sum score were independent predictors of absolute functional decline of the affected kidney (all P < 0.001), while only preoperative total GFR and DAP sum score were significantly associated with the total absolute GFR reduction (all P < 0.001).Conclusion Preoperative renal function status and DAP score of renal tumours are the primary determinants of long‐term functional outcomes after PN , but renal ischaemia damage to the operated kidney after PN is possibly masked by functional compensation of the contralateral healthy kidney if only overall renal function is assessed.