To estimate and quantify the loss of kidney function in solitary kidney with small renal masses (SRMs) after Laparoscopic Assisted Renal Cryoablation (LARC), from the European Registry for Renal Cryoablation (EuRECA) database.
Of the 808 patients from eight European centres in the database, 102 patients had SRMs in solitary kidneys. Patient demographics, Body Mass Index (BMI), American Society of Anaesthesiologists (ASA) grade, Charlson co-morbidity index, and tumour characteristics including nephrometry (PADUA) score where available were collected. Renal function data in the form of estimated glomerular filtration rate (eGFR) and Chronic Kidney Disease (CKD) stratification both pre-operatively and at 3 months postoperatively were collected.
The median (IQR) age was of 67 (range: 59-81) years, the median (IQR) BMI was 26 (23.9-28.9) kg/m2 and the median (IQR) ASA score was 2 (2-3). The median Charlson score was 4 (range 0-10). The median (IQR) tumour size in cross- sectional imaging was 26 (19-38) mm. The follow up data were available for 72 patients with a median follow- up for this group of 38 months (range 10 -132 months). The mean preoperative eGFR was 55.0 ml/min/1.73m2 (SD18.1) and the post -operative eGFR was 51.8 ml/min/1.73m2 (SD 18.8). The change was -3.1 ml/min/1.73m2 (-5.2, -1.0) (95%CI) units, which was statistically significant (P=0.004). The change in the CKD stages comparing before and after LARC was not significant (paired 2 tail t-test, P = 0.06). Critically, the decrease in the eGFR did not translate to any significant adverse outcome and 0 patients required dialysis.
To our knowledge this is the largest study of renal function following LARC in SRMs in solitary kidneys. Cryotherapy in this imperative situation is safe, carries clinically insignificant reduction in renal function therefore providing an option to minimise the risk of developing renal failure necessitating dialysis.
Journal of endourology. 2019 Nov 14 [Epub ahead of print]
Seshadri Sriprasad, Mohammed Aldiwani, Shiv Kumar Pandian, Tommy Kjærgaard Nielsen, Mohamed Ismail, Neil J Barber, Giovanni Lughezzani, Alessandro Larcher, Brunolf Lagerveld, Francis Keeley
Darent Valley Hospital, Urology, Darent Valley Hospital, Darenthwood Road, Kent, Dartford, Kent, United Kingdom of Great Britain and Northern Ireland, DA3 7RA; ., Darent Valley Hospital, Urology, Dartford, Kent, United Kingdom of Great Britain and Northern Ireland; ., Darent Valley Hospital, Urology, Dartford, Kent, United Kingdom of Great Britain and Northern Ireland; ., Aarhus University Hospital, Dep. of Urology, Aarhus, Denmark; ., Portsmouth Hospitals NHS Trust, 6698, Portsmouth, Portsmouth, United Kingdom of Great Britain and Northern Ireland; ., Frimley Park Hospital foundation trust, Urology, Camberley, Surrey, United Kingdom of Great Britain and Northern Ireland; ., IRCSS San Raffaele Hospital, URI - Urological Research Institute, Milan, Italy; ., IRCSS San Raffaele Hospital, URI - Urological Research Institute, Milan, Italy; ., Onze Lieve Vrouwe Gasthuis, Urology, Amsterdam, Netherlands; ., Bristol Urological Institute, Urology, Southmead Hospital, Westbury-on-Trym, Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland, BS9 3AN; .