Predictive Factors for Impaired Renal Function following Nephroureterectomy in Upper Urinary Tract Urothelial Cell Carcinoma

Objectives: Despite the uncertain value of adjuvant chemotherapy after radical nephroureterectomy (RNU) it is clear that impaired renal function represents a contraindication to its administration. The objective of this study was to identify possible predictive clinical factors for impaired renal function following RNU in patients with upper urinary tract urothelial cell carcinoma (UUT-UCC). Patients and Methods: A retrospective analysis was conducted of 546 patients who underwent RNU between 1992 and 2008 at our institution. Data of interest for this study included estimated glomerular filtration rate (eGFR), age, pathological stage and preoperative hydronephrosis (HN). The predictive value of HN, age and pathological stage for impaired renal function after RNU was calculated by multivariate linear regression analysis. Results: In total, 138 patients met the criteria for inclusion, including 108 men (78%). Mean age at surgery was 67 10 years. There was a significant correlation (p <0.001) between pre- and postoperative eGFR (decrease of 21% after NU). Preoperative HN was present in 51 patients (37%). On linear regression analysis, preoperative eGFR ml/min (p = 0.012; OR =4.60) and HN (p = 0.027; OR = 10.34) were confirmed be predictive factors for a postoperative eGFR ml/min. When postoperative eGFR ml/min was used as the criterion for impaired renal function, predictive factors proved to be preoperative eGFR ml/min (p <0.0001; OR = 18.53), HN (p = 0.038; OR = 0.380) and age years (p < 0.0001; OR = 0.169). Conclusions: Preoperative HN, older age and preoperative eGFR <60 rnl/rnin were proven to be predictive factors for impaired renal function after RNU. In these settings, neoadjuvant chemotherapy may be considered. (C) 2013 S. Karger AG, Basel