Kidney sparing surgery underutilized for patients who need it most

March 25, 2013

Researchers at the University of California, San Diego School of Medicine have released study results that show national treatment trends in the surgical management of patients with kidney disease. The study found that partial and complete kidney removal (total nephrectomy) and energy-based techniques to destroy tumors are all on the rise. Surprisingly, the patients most in need of kidney-sparing surgery are still more likely to undergo total nephrectomy. The findings recently published online in BJU International.

"While the overall proportion of patients receiving kidney preserving treatments for localized continues to grow, the most significant, and perhaps unsettling finding was that patients with kidney insufficiency still undergo complete – even though kidney preserving treatment may be indicated," said senior author Ithaar Derweesh, MD, urologic oncologist at UC San Diego Moores Cancer Center.

The kidney is a vital organ which performs a variety of functions in addition to making urine. It controls blood pressure, bone health, and also makes a hormone to tell the bone marrow to produce . Kidney insufficiency is characterized by a progressive decline in which may affect all of these actions.

"The study, which examined procedures over a 10-year period, found that patients with chronic kidney insufficiency had an almost two-fold higher probability of undergoing total nephrectomy than kidney preserving treatments, such as or tumor ablation," said Derweesh, a pioneer in minimally invasive kidney surgery.

Derweesh added that further investigation is needed to confirm these findings, and to examine what factors are responsible for patient and physician selection of treatment for . He noted that in the case of small renal masses less than four centimeters in size, partial nephrectomy has equivalent outcomes to total nephrectomy, and that ablation techniques, such as cryoablation or radiofrequency ablation, and observation are valid options for select patients.

While kidney insufficiency may result in total failure of the kidney, most patients do not progress to dialysis dependence. However, patients with worsening degrees of kidney insufficiency are at higher risk of cardiac events, such as heart attack and stroke, and osteoporosis and anemia.

The UC San Diego study utilized data from the Nationwide Inpatient Sample (NIS), the largest database of all annual hospital admissions in the United States. Approximately 443,850 procedures were included in the study.

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time and affects more than 26 million American adults. The two main causes of chronic are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Renal cell carcinoma is a commonly diagnosed urological malignancy with an estimated 57,760 new cases and 12,908 deaths in the United States during 2009.

Explore further: Mayo Clinic finds surgeon caseload, practice setting affect treatment of small kidney tumors

Related Stories

Kidney-preserving surgery saves bone health

August 5, 2011

Researchers at the University of California, San Diego School of Medicine have shed new light on how surgery impacts both chronic kidney disease and bone health, particularly in women. For the first time, their findings point ...

Recommended for you

Outside the body, a heart beats via life-saving system

September 1, 2015

(Medical Xpress)—A system that enables heart transplants involving hearts that stopped beating in the donor's body continues to save lives. The Organ Care System (OCS) has been used in UK hospitals with good results.

A recipe for long-lasting livers

April 22, 2015

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

Surgeon to offer ideas on a way to do human head transplants

February 26, 2015

Sergio Canavero of the Turin Advanced Neuromodulation Group has made it known that he intends to announce at this summer's American Academy of Neurological and Orthopedic Surgeons meeting, that he believes he has put together ...

New tool helps guide brain cancer surgery

July 3, 2014

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women's Hospital study.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.