Abstract: FR-PO527

Lack of Nephrologist Follow-Up after Nephrectomy for Kidney Cancer

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • McCusker, Michael Gerard, University of Maryland Medical Center, Baltimore, Maryland, United States
  • Carter-Monroe, Naima, University of Maryland, Baltimore, Maryland, United States
  • Cohen, Eric P., University of Maryland, Baltimore, Maryland, United States
Background

Medical renal disease often accompanies kidney cancer. The American College of Pathology recommends that the tissue surrounding a resected kidney cancer be examined to identify significant medical renal disease, much as is done for a kidney biopsy done for non-cancerous disease. This can inform regarding pathogenesis of kidney cancer and is immediately important for nephrologic management of patients who have had nephrectomy, partial or complete.

Methods

We tested a prospectively maintained database at the Baltimore Veterans Affairs Medical Center to determine the adequacy of follow-up in such cases. Sixty six patients were identified from 2010 through 2016, who had at least six months of follow-up after surgery.

Results

All but one were men and 46 were black. The average age was 64 +/- 7 (sd). Forty-one had total and twenty-seven had partial nephrectomies. Two patients had partial followed by contralateral total nephrectomy. Twenty seven of the sixty eight had clear cell cancer, the rest were papillary. Thirteen patients with oncocytomas were not included. In the pathology reports, six had no comment regarding the non-cancerous renal tissue. Eight more reported no abnormality, but twenty four showed moderate or worse medical renal disease of the non-cancerous renal tissue. As reported by others, micro and macrovascular disease were present in the non-cancerous tissue of the majority of cases. The average preoperative serum creatinine (s creat) of the patients was 1.3 mg/dl +/- 0.6 (sd). The average discharge s creat was 1.7 mg/dl +/- 0.9 (sd). (p<0.001 vs preoperative s creat). The average s creat at one year was 1.8 mg/dl +/- 1.2 (sd). Only 23 of these 66 patients had any nephrology follow-up after their surgery, and only 13 had measurement of proteinuria.

Conclusion

We conclude that although Pathologists usually provide some report of the non-cancerous renal tissue, this is still not always done. The majority of cases show significant medical renal disease in the surrounding non-cancerous kidney. Importantly, nephrologic follow-up of these patients with chronic kidney disease is deficient. Because of the known risks of CKD, it is prudent to ensure Nephrologist follow-up for patients who have had a nephrectomy for kidney cancer.

Funding

  • Veterans Affairs Support