Renal cell carcinoma in patients with end‐stage renal disease has favorable overall prognosis

Patients with end‐stage renal disease (ESRD) demonstrate a greater risk for renal cell carcinoma (RCC) than the general population. This study compared pathological and clinical outcomes in patients with RCC with and without ESRD. Patients with ESRD who underwent nephrectomy and were found to have RCC at our institution since 1999 were identified. The control group was composed of patients from the general population with RCC. The primary outcome was risk of cancer recurrence. The study included 338 RCC patients: 84 with ESRD and 243 without ESRD. In the ESRD group, mean tumor size was smaller, there was decreased prevalence of advanced T category (>3) , and the average Karakiewicz nomogram score was lower. ESRD was associated with decreased tumor recurrence and clear cell pathology. No patients with ESRD had metastatic disease. There was no difference in overall or cancer‐specific mortality between the ESRD and control groups. Patients with ESRD who develop RCC have a better prognosis compared to RCC in patients without ESRD, which is likely secondary to favorable histopathologic phenotype as well as the likelihood of early diagnosis. Thus, the delay between nephrectomy and renal transplantation may not be necessary, especially in patients with asymptomatic, low grade tumors.     

Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease.

BACKGROUND: Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. METHODS: In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. RESULTS: Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. CONCLUSION: ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.     

Renal cell carcinoma and end stage renal disease

PURPOSE: Patients with ESRD secondary to acquired renal cystic disease have been reported to have a higher incidence of RCC than the general population. We examined the clinical and pathological significance of incidental renal masses in patients with ESRD. MATERIALS AND METHODS: From January 1994 to July 2000, 852 consecutive patients with ESRD who were being considered for renal transplantation at University of Mississippi Medical Center were evaluated with renal ultrasound as part of assessment for possible kidney transplantation. Those patients with ultrasound suspicious for a malignant renal lesion were further evaluated with CT of the abdomen with and without intravenous contrast medium. Any patient with CT findings suspicious for RCC was recommended to undergo radical nephrectomy before kidney transplantation. RESULTS: A total of 19 patients had CT criteria for a possible malignant renal lesion. Seven patients had Bosniak class 3 renal cysts and 12 patients had solid, enhancing renal masses. Of the patients 17 underwent radical nephrectomy. On pathological examination 14 patients had RCC with a 1.64% prevalence in the population screened. Mean Fuhrman nuclear grade in our patients was 2.45. CONCLUSIONS: RCC in patients with ESRD are of clinical significance, considering the size, grade, histology and pathological stage of these tumors. The higher prevalence of clinically significant RCC in patients with ESRD as well as the risk of cancer progression while patients are on immunosuppressive medications justifies screening for RCC in patients with ESRD who are awaiting renal transplantation.     

Renal cell carcinoma as a cause of end-stage renal disease in the United States: patient characteristics and survival

BACKGROUND: The patient characteristics and mortality associated with renal cell carcinoma (RCC) as a cause of end-stage renal disease (ESRD) have not been characterized for a national population. METHODS: An historical cohort study of renal cell carcinoma (RCC) was conducted from April 1, 1995, to December 31, 1999. Included were 360,651 patients in the United States Renal Data System (USRDS) who were initiated on ESRD therapy with valid causes of ESRD. RESULTS: Of the study population, 1646 patients (0.5%) had RCC. The mean age of patients with RCC was 66.8 +/- 14.6 years versus 61.3 +/- 16.4 years for patients with other causes of ESRD (P < 0.01 by Student t test). The unadjusted 3-year survival (censored at the date of renal transplantation) of patients with RCC during the study period was 23% versus 36% in all other patients [adjusted hazard ratio (AHR), 1.10, 95% confidence interval (CI) 1.02-1.19, P = 0.019 by Cox regression]. However, patients with RCC who underwent nephrectomy (bilateral or unilateral) had significantly better survival compared to RCC patients who did not (AHR, 0.73, 95% CI, 0.63-0.85, P < 0.01), and their survival was not significantly different in comparison with nondiabetic ESRD patients. Bilateral nephrectomy (vs. unilateral) was not associated with any difference in adjusted mortality. CONCLUSION: Among patients with ESRD, the demographics of those with RCC were similar to those of patients with RCC in the general population. Overall, patients with RCC had decreased survival compared to patients with other causes of ESRD; those who underwent nephrectomy had significantly better survival than those who did not, with survival comparable to patients with nondiabetic ESRD.     

Acquired renal cystic disease in children and young adults on maintenance dialysis

Acquired renal cystic disease (ARCD) is a well-known complication of end-stage renal disease (ESRD). We studied 24 patients, aged 8 – 27 years (mean 19.8±5.3 years), on chronic maintenance dialysis in our service. The duration of dialysis ranged between 13 and 192 months (mean 77.8±44.3 months). High-resolution ultrasonography revealed ARCD in 11 (45.8%) patients. No cysts were seen in 7 (29.1%) patients and solitary cysts in one or both kidneys were seen in 6 (25%) patients. Renal malignancy was diagnosed in 2 patients. One, 15 years old, had renal cell carcinoma after being on dialysis for 6 years. She did well after bilateral nephrectomy, left salpingo-oophorectomy, and regional lymphadenectomy. The second patient, 23 years old, had been on dialysis for 16 years when she developed renal oncocytoma. She died of congestive cardiomyopathy 6 months later. We conclude that ARCD is common in children and young adults with ESRD. Neoplastic transformation, although rare, is a potential complication. Annual follow-up with ultrasonography with selective use of computed tomography or magnetic resonance imaging is advised. Received July 29, 1996; received in revised form and accepted November 15, 1996     

Acquired renal cystic disease in HD: a study of 82 nephrectomies in young patients.

In order to study the development of acquired renal cystic disease (ARCD) and its potential complications, we studied, macro- and microscopically, 82 surgical specimens of nephrectomy carried out on young patients with chronic renal failure previous to renal transplantation. Statistical correlation of pathological findings with age, sex and time on hemodialysis (HD) have been done. There were 72 cases of ARCD (87.8%). It was statistically correlated with male sex (p less than 0.02) and prolonged time on HD (p less than 0.001) as has been previously reported. Hyperplasia of the cystic epithelium was found in 42 cases (52%), with 18 (22%) showing marked papillary proliferation. Also, there were 22 cases (27%) with renal adenomas. This incidence of hyperplastic and neoplastic proliferations, more than would be common in such a young population (males: 33.5 +/- 9.3 years; females: 35.4 +/- 11.7 years), suggests the potential of patients affected by ARCD to develop neoplasms. Thus, we consider that these patients must be checked periodically to detect possible malignant neoplasms.     

Kidney disease progression in patients of upper tract urothelial carcinoma following unilateral radical nephroureterectomy

Objectives: To compare the renal outcomes in patients of unilateral renal cell carcinoma (RCC) with upper tract urothelial carcinoma (UTUC) following surgical resection of the tumor-bearing kidney, and to investigate the potential predictors in renal function decline. Patients and methods: In this retrospective cohort study, 319 RCC patients undergoing radical nephrectomy (RN) and 297 UTUC patients undergoing radical nephroureterectomy were recruited from a tertiary medical center between 2001 and 2010. Demographic data, co-morbidity, smoking habit, baseline estimated glomerular filtration rate (eGFR) calculated by chronic kidney disease-epidemiology equation, as well as tumor staging of RCC and UTUC, were recorded. The primary endpoint was serum creatinine doubling and/or end-stage renal disease (ESRD) necessitating long-term dialysis. Cox proportional hazard model and Fine and Gray's competing risk regression accounting for death were used to model renal outcome. Results: UTUC patients had a higher incidence rate of renal function deterioration than RCC patients did (15.01 vs. 2.68 per 100 person-years, p<0.001). In Cox proportional hazard model and Fine and Gray's competing risk regression, UTUC was significantly associated with increased risk of creatinine doubling and/or ESRD necessitating dialysis (hazard ratio, 3.13; 95% confidence interval, 2.01–4.87) as compared to RCC following unilateral RN. Nevertheless, our study is observational in nature and cannot prove causality. Conclusions: UTUC per se is strongly associated with kidney disease progression as compared to RCC following unilateral nephrectomy. Further studies are needed to elucidate this association.     

Acquired renal cystic disease: two cases of associated adenocarcinoma and a renal ultrasound survey of a peritoneal dialysis population

Long-term dialysis patients frequently develop acquired renal cystic disease (ARCD). The discovery of ARCD and renal cell carcinoma in one of our hemodialysis patients led us to review the literature. ARCD has been described mainly in the maintenance hemodialysis (MH) population. Therefore, we investigated 20 peritoneal dialysis (PD) patients for ARCD using ultrasonography. Seven patients (35%) had detectable cysts and two patients (10%) had multiple bilateral cysts. One patient had a large asymptomatic complex cyst that proved to be an adenocarcinoma. Our study suggests that ARCD is relatively common in the PD population, and we speculate that it may be related more to length of time in end-stage renal disease (ESRD) than to the mode of dialysis. The potential for malignant change appears to justify a routine screening examination with ultrasonography and/or computerized tomography (CT) to detect this recently described and probably underrecognized entity.     

Living donor renal transplantation with incidental renal cell carcinoma from donor allograft

To report our series of cases with living donor kidney transplant by laparoscopic nephrectomy with incidental renal cell carcinomas (RCC) at the time of transplant. We performed a search of cases of renal allografts from living donors with incidental tumors which were confirmed as RCC in final pathology. The graft nephrectomy was performed via hand‐assisted laparoscopic procedure. All cases underwent partial nephrectomy of the tumor during the back‐table preparation of the graft and sent for pathological analysis. We performed 435 living donor kidney transplants at our Institution and identified four cases consistent with the diagnosis of RCC. Two of them were clear cell type, one papillary and one multilocular RCC. All the tumors presented at stage I of TNM classification. After a median follow‐up of 36 months, three patients remain free of dialysis with good allograft function. One noncompliant patient presented with a glomerular filtration rate (GFr) below 15 ml/min after a BK viral infection. At the end of follow‐up period, all patients had remained free of tumor. Donors with suspicious renal masses might be accepted for living donation. Partial nephrectomy before transplantation could offer a cure for the disease without risks for the recipient with therapeutic benefit for the donor.     

Epidemiology of end-stage renal failure in Reunion Island (results from the registry of the Indian Ocean Society of Nephrology)

Background: End-stage renal disease (ESRD) on long-term dialysis is a substantial problem in Reunion because of the high incidence and prevalence of this disease due to non-insulin-dependent diabetes mellitus (NIDDM) and systemic arterial hypertension. Subjects and methods: In 1996 the renal study group of the Indian Ocean Society of Nephrology established a regional registry of end-stage renal failure (ESRD) on long-term dialysis. The present report summarizes data obtained from this registry. Results: In 1996, there were 125 patients who were initiated on long-term dialysis, 657 patients on dialysis with a mean age 52±17 years, and 110 patients with a functioning kidney graft. The incidence rate of ESRD was 188 per million population (p.m.p.) and the prevalence rate of this pathology was 1155 p.m.p. The sex ration (F/M) was 1.4/1. The two most common causes of ESRD were NIDDM in 33.6% and systemic arterial hypertension in 27.5%. The mean Kt/V value was 1.47±0.23 and the mortality rate was 8.1% per year. Conclusion: The results demonstrate high incidence and prevalence rates of ESRD mainly as a result of NIDDM and systemic arterial hypertension. Key words: diabetes mellitus; dialysis; end-stage renal failure; hypertension      

Prévalence de l’IRCT en 2011

This chapter describes temporal and geographical variations of ESRD prevalence in France. This indicator assesses health needs of ESRD patients on dialysis or living with functional transplant. It does not include patients on conservative treatment. On December 31, 2011, 70 300 patients were receiving a renal replacement therapy in one of the 25 regions contributing to the registry, 39 200 (56%) on dialysis and 31 100 (44%) living with a functional renal transplant. The overall crude prevalence was 1091 pmh. It was 1.6 higher in males. Prevalence was subject to regional variations with 5 regions (3 overseas) above the national rate. Renal transplant share varied from 33% in Nord-Pas-de-Calais to 53% in Pays de Loire, and from 16 to 25% in overseas regions.The overall sex and age standardised prevalence was 40, 567 and 483 pmh respectively for peritoneal dialysis, haemodialysis and transplantation, with marked regional variations. The study of temporal variations for 18 regions contributing to the registry since 2007 demonstrated a +4% increase in standardised prevalence of ESRD patients with a functional transplant vs +2% increase for dialysis, resulting in a decreasing gap between dialysis and transplantation prevalence, due to an increase number of renal transplant and a longer survival of transplanted patients. Such an evolution should prompt the nephrological community and health authorities to anticipate changes in the ESRD healthcare organisation and to adapt them to the regional context.     

术前影像诊断肾癌的肾脏良性病变发生率及预测因素分析

目的:研究在中国患者中术前影像学诊断肾癌行肾脏部分切除手术或根治性肾切除手术的肾脏良性占位病变发生率,并分析其预测因素。方法:回顾性分析从2003年1月～2010年9月共1 531例术前影像学诊断为肾癌并行肾脏部分切除手术或根治性肾切除手术患者的临床资料,多因素回归分析术后病理检查证实为良性患者的临床病理资料。结果:在1 531例患者中,共有81例(5.3%)为良性,其中包括错构瘤52例(3.4%),嗜酸细胞腺瘤12例(0.8%),复杂性囊肿6例(0.3%),其他类型11例(0.7%)。单因素分析显示女性、肿瘤最大径较小、年龄较小、囊性占位病变为临床表现者,病理检查证实为良性的可能性大。多因素回归分析显示,女性(OR,3.13;95%CI,1.95～5.04;P<0.001)、肿瘤最大径较小(OR,0.75;95%CI,0.66～0.85;P<0.001)、年龄较小(OR,0.94;95%CI,0.92～0.96;P<0.001)是良性占位病变的独立预测因素,而囊性占位病变不是显著性预测因素。结论:在中国患者中,术前影像学检查诊断为肾癌术后病理检查证实为良性病变的发生率为5.3%,较国外同类研究明显偏低。良性占位病变中最常见的类型为错构瘤,而欧美同类研究中为嗜酸细胞腺瘤。女性、年龄较小、肿瘤最大径较小是良性占位病变的独立预测因素。     

Partial nephrectomy used to treat renal cell carcinoma arising in a live donor transplant kidney

There are few reported cases of renal cell carcinoma (RCC) arising in kidney allografts. Whether these tumours occur due to post-transplant malignant transformation or are present at the time of transplantation is unclear. The influence of immunosuppression must be considered in their development, progression and treatment. We report a case of a RCC presenting asymptomatically in a functioning live donor renal allograft 173 months after transplantation. In an attempt to avoid return to dialysis treatment, a partial nephrectomy was carried out. To optimise the procedure, and to assure cancer clearance, combined intraoperative ultrasound and frozen section analysis were used. Our patient remains disease free and dialysis independent at 22 months follow up. To our knowledge, this patient represents the only live donor organ transplant tumour reported to be treated using nephron-sparing surgery and remain dialysis independent. Partial nephrectomy should be considered as a treatment option in such cases.     

Renal cell carcinoma in peritoneal dialysis patients

Renal cell carcinoma is a rare but serious complication in ESRD patients. In these patients the incidence of renal cell carcinoma (RCC) is 20-40 times higher than in the general population. We performed a retrospective study to measure the incidence rate, prevalence, characteristics and survival among our peritoneal dialysis (PD) patients diagnosed with renal cell carcinoma. The study was carried out among 607 patients who were on the PD program from January 1997 to June 2002. RCC was detected in eight patients (four males and four females) with mean age of 52.1 +/- 10.6 years. Among these eight patients four were new cases that were diagnosed before the patients were started on dialysis (three in native kidneys and one in a transplanted kidney). In the other four patients the RCC was diagnosed after they had been on dialysis for 33-204 months (mean 60.75 +/- 50.48). We found an incidence rate of 1.3 per 1000 patients per year and a prevalence of 1.3%. Six of the eight patients had renal cysts. Tumor size was less than 7 cm in seven patients and in the other patient it was 8.5 cm. Seven of eight patients were alive at the time of study with a survival time ranging from 3-138 months (mean 122.25 +/- 88.2) months. In one patient, the RCC metastasised to the scalp, and, in two other patients, the tumors subsequently involved the second kidney. A cardiovascular complication was the cause of one death. Two patients received a renal transplant 36 and 66 months after diagnosis. We conclude that despite the low rate of metastases and mortality in our study, regular ultrasonography should be added to the follow-up of PD patients. Renal transplantation can be considered in these ESRD patients with RCC; however, close follow-up for metastases is recommended.     

Renal cell carcinoma in patients with end‐stage renal disease: relationship between histological type and duration of dialysis

Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To evaluate the clinical outcomes and histological types of renal cell carcinoma (RCC) arising in patients with end‐stage renal disease (ESRD), and to analyse the relationship of histopathological features with the duration of dialysis.

PATIENTS AND METHODS

Clinical characteristics and outcomes of 34 patients who had a radical nephrectomy for RCC arising in ESRD between November 1994 and June 2008 were investigated. Archive paraffin‐embedded tissue specimens obtained from 27 patients were histochemically and immunohistochemically analysed to determine the histopathological type.

RESULTS

There was one death from cancer and one patient with local progression within a median observation period of 29.5 months. Acquired cystic disease (ACD)‐associated RCC, clear cell‐papillary RCC, mucinous tubular and spindle‐cell carcinoma, and Xp11.2 translocation/TFE3 gene fusion were identified in eight, two, three and one patient, respectively. Conventional clear‐cell RCC was the predominant histological type (nine of 15) in patients with a duration of dialysis of <10 years, while ACD‐associated RCC was predominant (seven of 12) in those with dialysis for ≥10 years. Sarcomatoid foci were identified in three patients with dialysis for ≥10 years. Papillary adenoma was microscopically identified as a satellite tumour in 10 patients.

CONCLUSION

The spectrum of histological types of RCCs arising in ESRD is distinct from that of sporadic RCCs. Patients with a longer duration of dialysis should have particular attention for progression and metastasis. Immunohistochemical profiling is efficient in the histological classification of RCCs arising in ESRD, although knowledge about genetic changes remains to be accumulated.     

Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

BACKGROUND: Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. METHODS: We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. RESULTS: Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. CONCLUSIONS: ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.     

The management of end-stage renal disease in infants with imperforate anus

Genitourinary malformations are frequently associated with imperforate anus, and death from renal failure is reported in up to 6% of children with supralevator imperforate anus. In recent years, advances in renal transplantation and the management of end-stage renal disease (ESRD) have extended these therapies to infants in the first 2 years of life. In infants with imperforate anus and ESRD, it is unclear if the additional burdens of the anorectal malformation and its staged repair contraindicate dialysis and transplantation. This report describes our experience with three such infants and outlines an approach to their care, addressing the following key issues: the initial surgical management of the imperforate anus, the careful search for associated urinary tract and other malformations, the ESRD management, and the appropriate timing of the staged bowel reconstruction and renal transplantation. These cases confirm that such children may be successfully managed by dialysis and renal transplantation co-ordinated with bowel reconstruction; however, there remain the longterm risks of immunosuppression, bladder and bowel dysfunction, and associated congenital anomalies.     

Cystic renal cell carcinoma,suspected because of lack of regression of renal cysts after renal transplantation in a dialysis patient with acquired renal cystic disease

A 34-year-old man who had been on dialysis for about 6 years, and had acquired renal cystic disease, received a renal transplantation. However, in spite of the success of the transplantation, one area without cyst regression was observed in the original kidney. Therefore, carcinoma was suspected and nephrectomy was performed. Histology revealed cystic renal cell carcinoma (RCC). No case of cystic RCC occurring in a dialysis patient has previously been reported. Cystic RCC should be suspected in a cystic mass in the original kidney which does not regress after successful renal transplantation. Received: August 23, 2002 / Accepted: November 25, 2002 Acknowledgments We thank Dr. Shigehiko Sato, Department of Internal Medicine, Tonami General Hospital, who referred this patient to us. Correspondence to:I. Ishikawa     

The clinicopathological characteristics in renal cell carcinoma with end-stage renal disease

OBJECTIVES: The influence and the interdependence of pathological and clinical factors on prognostic differences between renal cell carcinoma (RCC) with end-stage renal disease (ESRD) and RCC without ESRD after nephrectomy has remained unclear. We compare the clinicopathological features between RCC with and without ESRD. MATERIALS AND METHODS: From June 1993 to May 2000, 150 RCC patients who underwent nephrectomy were pathologically defined to have pT1 to pT3NXM0. The patients were followed for 1 to 84 months (median 30 months) after the surgery. Total of 16 patients with ESRD and 134 patients without ESRD were studied, and the differences of clinicopathological features between two groups were statistically compared. RESULTS: We compare the clinicopathological features between RCC with and without ESRD. Patients' age, tumor size, rate of incidental cancer, pathological T stage, and grade were not significantly different between two groups. The 5-year recurrence-free probability rate was significantly higher in patients without ESRD than in patients with ESRD (log-rank test: p = 0.04). The status of ESRD, patients age and pathological T stage were significant predictors of recurrence when analyzed by Cox proportional hazards analysis (p = 0.01, p = 0.03 and p = 0.02, respectively). CONCLUSIONS: This study demonstrated that the ESRD is an independent prognostic factor in RCC patients after surgery. These results reflect that the patients with ESRD have higher risk of tumor progression. Therefore, early detection of tumors is particularly important in these patients by regular abdominal ultrasound or CT screening.     

氮质血症期肾癌患者接受腹腔镜肾部分切除术后的肾功能转归

目的总结氮质血症期肾癌(RCC)患者接受腹腔镜下肾部分切除术(LPN)治疗后的肾功能变化规律,并初步探讨影响其术后透析事件的可能临床因素。方法回顾性总结26例氮质血症期RCC患者的所有临床病理资料及肾功能随诊资料,观察血尿素氮(BUN)、血肌酐(Scr)以及总肾小球滤过率(GFR)的变化趋势,并分析可能影响患者术后透析的临床因素。结果所有患者的年龄范围在54~76岁之间,中位年龄64岁。术后1年内,全组患者中共5例患者(19.2%)的肾功能进入了衰竭期,3例患者(11.5%)接受了血液透析治疗。术后1年时,BUN和Scr分别增长了54.5%和58.5%,而总GFR则减少了32.5%。单因素分析显示:肾功能不全的病因、肿瘤原位分期以及术中失血量可能是影响术后是否需要透析治疗的有意义因素。多因素分析显示:肾功能不全的病因才是术后透析的独立风险因素。结论是否存在术前肾血管狭窄性病变可能是氮质血症期RCC患者术后透析事件的独立风险因素。