Optimising assessment of kidney function when managing localised renal masses

Ellis, Robert J; Joshi, Andre; Ng, Keng L; Francis, Ross S; Gobe, Glenda C; Wood, Simon T

doi:10.5694/mja17.00161

Topics

Urologic diseases

Neoplasms

Summary

Increased early and incidental detection, improved surgical techniques and technological advancement mean that the management of renal mass lesions is constantly evolving.
The treatment of choice for renal mass lesions has historically been radical nephrectomy.
Partial nephrectomy is now recommended for localised renal masses, owing to favourable renal functional outcomes.
Ablative renal surgery confers a significant risk of chronic kidney disease.
There are few studies assessing long term outcomes of nephrectomy on renal outcomes, and virtually no studies assessing long term outcomes for less invasive therapies such as ablation.
Unless a renal mass is clearly benign on imaging, management decisions will be made with an assumption of malignancy. The content of this review applies to both benign and malignant renal mass lesions.
We advocate for improved strategies for kidney function assessment and risk stratification, early targeted referral, and regular screening for chronic kidney disease for all patients after surgery.

1 University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD
2 Princess Alexandra Hospital, Brisbane, QLD
3 Australian Prostate Cancer Research Centre, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
4 NHMRC Chronic Kidney Disease Centre for Research Excellence (CKD.QLD), University of Queensland, Brisbane, QLD

Correspondence: r.ellis1@uq.edu.au

Acknowledgements:

Robert Ellis was supported by an Australian Government Research Training Scholarship.

Competing interests:

No relevant disclosures.

1. Znaor A, Lortet-Tieulent J, Laversanne M, et al. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol 2015; 67: 519-530.
2. Kidney Disease: Improving Global Outcomes CKD Workgroup. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150.
3. Kim SP, Murad MH, Thompson RH, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 2012; 188: 51-57.
4. Australian Institute of Health and Welfare. Cancer Incidence Projections: Australia, 2011-2020 (AIHW Cat. No. CAN 62; Cancer Series No. 66). Canberra: AIHW; 2012.
5. Ta AD, Bolton DM, Dimech MK, et al. Contemporary management of renal cell carcinoma (RCC) in Victoria: implications for longer term outcomes and costs. BJU Int 2013; 112 Suppl 2: 36-43.
6. Satasivam P, Reeves F, Rao K, et al. Patients with medical risk factors for chronic kidney disease are at increased risk of renal impairment despite the use of nephron-sparing surgery. BJU Int 2015; 116: 590-595.
7. Srigley JR, Delahunt B, Eble JN, et al. The International Society of Urological Pathology (ISUP) Vancouver classification of renal neoplasia. Am J Surg Pathol 2013; 37: 1469-1489.
8. Samaratunga H, Gianduzzo T, Delahunt B. The ISUP system of staging, grading and classification of renal cell neoplasia. J Kidney Cancer VHL 2014; 1: 26-39.
9. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2017.
10. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67: 913-924.
11. Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182: 1271-1279.
12. Sanchez-Martin FM, Millan-Rodriguez F, Urdaneta-Pignalosa G, et al. Small renal masses: incidental diagnosis, clinical symptoms, and prognostic factors. Adv Urol 2008: 310694.
13. Pierorazio PM, Johnson MH, Ball MW, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol 2015; 68: 408-415.
14. Kim HL, Belldegrun AS, Freitas DG, et al. Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol 2003; 170: 1742-1746.
15. Yap NY, Ng KL, Ong TA, et al. Clinical prognostic factors and survival outcome in renal cell carcinoma patients — a Malaysian single centre perspective. Asian Pac J Cancer Prev 2013; 14: 7497-7500.
16. Giannarini G, Petralia G, Thoeny HC. Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol 2012; 61: 326-340.
17. Fowler C, Reznek R. The indeterminate renal mass. Imaging 2001; 13: 27-43.
18. Pallwein-Prettner L, Flöry D, Rotter CR, et al. Assessment and characterisation of common renal masses with CT and MRI. Insights Imaging 2011; 2: 543-556.
19. Bosniak MA. The Bosniak renal cyst classification: 25 years later. Radiology 2012; 262: 781-785.
20. Warren KS, McFarlane J. The Bosniak classification of renal cystic masses. BJU Int 2005; 95: 939-942.
21. Frank I, Blute ML, Cheville JC, et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003; 170: 2217-2220.
22. Sankineni S, Brown A, Cieciera M, et al. Imaging of renal cell carcinoma. Urol Oncol 2016; 34: 147-155.
23. Mueller-Lisse UG, Mueller-Lisse UL. Imaging of advanced renal cell carcinoma. World J Urol 2010; 28: 253-261.
24. Rhee H, Blazak J, Tham CM, et al. Pilot study: use of gallium-68 PSMA PET for detection of metastatic lesions in patients with renal tumour. EJNMMI Res 2016; 6: 76.
25. Okhunov Z, Rais-Bahrami S, George AK, et al. The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores. J Endourol 2011; 25: 1921-1924.
26. Patel HD, Johnson MH, Pierorazio PM, et al. Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature. J Urol 2016; 195: 1340-1347.
27. Marconi L, Dabestani S, Lam TB, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol 2016; 69: 660-673.
28. Andersen MF, Norus TP. Tumor seeding with renal cell carcinoma after renal biopsy. Urol Case Rep 2016; 9: 43-44.
29. Masson-Lecomte A, Bensalah K, Seringe E, et al. A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study. BJU Int 2013; 111: 256-263.
30. Choi JE, You JH, Kim DK, et al. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 2015; 67: 891-901.
31. Smaldone MC, Kutikov A, Egleston BL, et al. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 2012; 118: 997-1006.
32. Su MZ, Memon F, Lau HM, et al. Safety, efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma. Int Urol Nephrol 2016; 48: 1609-1616.
33. Nielsen TK, Lagerveld BW, Keeley F, et al. Oncological outcomes and complication rates after laparoscopic-assisted cryoablation: a European Registry for Renal Cryoablation (EuRECA) multi-institutional study. BJU Int 2017; 119: 390-395.
34. Lane BR, Demirjian S, Derweesh IH, et al. Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate. Eur Urol 2015; 68: 996-1003.
35. Johnson DW, Atai E, Chan M, et al. KHA-CARI guideline: early chronic kidney disease: detection, prevention and management. Nephrology 2013; 18: 340-350.
36. Jeon HG, Jeong IG, Lee JW, et al. Prognostic factors for chronic kidney disease after curative surgery in patients with small renal tumors. Urology 2009; 74: 1064-1068.
37. Jeon HG, Choo SH, Jeong BC, et al. Uric acid levels correlate with baseline renal function and high levels are a potent risk factor for postoperative chronic kidney disease in patients with renal cell carcinoma. J Urol 2013; 189: 1249-1254.
38. Torricelli FC, Danilovic A, Marchini GS, et al. Can we predict which patients will evolve to chronic kidney disease after nephrectomy for cortical renal tumors? Int Braz J Urol 2012; 38: 637-643; discussion 644.
39. Malcolm JB, Bagrodia A, Derweesh IH, et al. Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy. BJU Int 2009; 104: 476-481.
40. Klarenbach S, Moore RB, Chapman DW, et al. Adverse renal outcomes in subjects undergoing nephrectomy for renal tumors: a population-based analysis. Eur Urol 2011; 59: 333-339.
41. Jeon HG, Choo SH, Sung HH, et al. Small tumour size is associated with new-onset chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma. Eur J Cancer 2014; 50: 64-69.
42. Zabor EC, Furberg H, Mashni J, et al. Factors associated with recovery of renal function following radical nephrectomy for kidney neoplasms. Clin J Am Soc Nephrol 2016; 11: 101-107.
43. Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA 2011; 305: 1553-1559.
44. Weight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 2010; 183: 1317-1323.
45. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612.
46. Kidney Disease: Improving Global Outcomes AKI Workgroup. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1-138.
47. Hu SL, Chang A, Perazella MA, et al. The nephrologist's tumor: basic biology and management of renal cell carcinoma. J Am Soc Nephrol 2016; 27: 2227-2237.
48. Henriksen KJ, Meehan SM, Chang A. Nonneoplastic kidney diseases in adult tumor nephrectomy and nephroureterectomy specimens: common, harmful, yet underappreciated. Arch Pathol Lab Med 2009; 133: 1012-1025.
49. Cho A, Lee JE, Kwon GY, et al. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transplant 2011; 26: 3496-3501.
50. Trehan A. Comparison of off-clamp partial nephrectomy and on-clamp partial nephrectomy: a systematic review and meta-analysis. Urol Int 2014; 93: 125-134.
51. Mir MC, Pavan N, Parekh DJ. Current paradigm for ischemia in kidney surgery. J Urol 2016; 195: 1655-1663.
52. Chung JS, Son NH, Byun SS, et al. Trends in renal function after radical nephrectomy: a multicentre analysis. BJU Int 2014; 113: 408-415.
53. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. 3rd ed. Melbourne: KHA, 2015. http://kidney.org.au/health-professionals/prevent/chronic-kidney-disease-management-handbook (accessed June 2017).

Online responses are no longer available. Please refer to our instructions for authors page for more information.