Kidney Week

Abstract: SA-PO1242

Performance of a Score for Stratifying the Risk of Significant CKD and Predictors of GFR Decline in Patients with Renal Cell Carcinoma Undergoing Nephrectomy

Session Information

• Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Pereira, Benedito J., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil

Benedito J. Pereira, MD, PhD

• Kassar, Liliana M L, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Liliana M L Kassar, MD

• Silva, Karoline W C, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil

Karoline W C Silva, MD

• Alves de Melo, Pedro Gregorio, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, SP, Brazil

Pedro Gregorio Alves de Melo, MD

• Lutf, Luciana Gil, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Luciana Gil Lutf, MD

• Mattedi, Francisco Zanotelli, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Francisco Zanotelli Mattedi, MD

• Caires, Renato A., Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Renato A. Caires, MD

• Cordeiro, Mauricio Dener, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Mauricio Dener Cordeiro, MD, PhD

• Nahas, William C., Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

William C. Nahas, PhD

• Zanetta, Dirce M T, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, SP, Brazil

Dirce M T Zanetta, MD, PhD

• Burdmann, Emmanuel A., Universidade de Sao Paulo Faculdade de Medicina, São Paulo, SP, Brazil

Emmanuel A. Burdmann, MD, PhD

• Costa e Silva, Veronica Torres, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, São Paulo, SP, Brazil

Veronica Torres Costa e Silva, MD, PhD

Background

Nephrectomy for renal cell carcinoma (RCC) is associated with an increased risk of glomerular filtration rate (GFR) decline. Clinical tools have been developed to stratify postoperative risk, but lack external validation

Methods

We evaluated the performance of the Australian Risk Stratification Score (ARSS) and predictors of GFR decline in a cohort of adult patients with estimated GFR based on the serum level of creatinine (eGFRcr)>60 ml/min/1.72m²and histologically confirmed RCC submitted to nephrectomy between January 2010 and December 2021 at a Brazilian Cancer Institute. Baseline eGFRcr was the estimate closest to the nephrectomy, and the eGFRcr used for the outcomes at follow-up was the median of estimates collected between 12 and 24 months after nephrectomy. The primary outcome was eGFRcr ≤45 mL/min/1.73m² applied to the ARRS score; secondary outcomes were incident CKD (eGFRcr < 60 ml/min/1.72m²), eGFRcr decline ≥30%, and ≥40% compared to the baseline period.

Results

Among 438 patients (mean age 57.7±10.5 years; 58% male), 58% had hypertension, 24.2 % diabetes, 72.1% underwent partial nephrectomy, and 46.8% had post-nephrectomy acute kidney injury (AKI). ARSS demonstrated good discrimination (C statistic: 0.87, 95% CI 0.82–0.93; p=0.01) but overestimated the outcome in the moderate (21-26% vs 11.1%) and high-risk categories (46-60% vs 40%). At follow-up, independent predictors of incident CKD, eGFRcr decline ≥30 and 40% were older age, diabetes, baseline eGFRcr, radical nephrectomy, and post-nephrectomy AKI (Table).

Conclusion

This is the first study demonstrating the robustness of a post-nephrectomy score predictive of GFR decline in a Latin American population. Additionally, AKI was a strong independent predictor of functional loss. These results support the utility of validated tools to select patients who may benefit from strategies to preserve kidney function after nephrectomy.