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: Researchers identify link between kidney removal and erectile dysfunction

Related Stories

Researchers identify link between kidney removal and erectile dysfunction

July 30, 2012
Researchers at the University of California, San Diego School of Medicine have identified a link between patients who undergo total nephrectomy - complete kidney removal - and erectile dysfunction. Results from the multi-center ...

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 ...

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

May 15, 2011
Patients with small kidney tumors are more likely to be offered treatment options based on surgeons' case volume and type of practice than on tumor characteristics, a Mayo Clinic study has found. Fellowship-trained surgeons ...

Kidney cancer patients do better when whole kidney is not removed

April 17, 2012
Kidney cancer patients who had only their tumor removed had better survival than patients who had their entire kidney removed, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

Chronic kidney disease a recipe for kidney failure? Not necessarily

March 8, 2012
Not all patients with chronic kidney disease (CKD) are destined for kidney failure, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings provide hope that ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

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.