Chronic kidney disease and small renal tumors: What urologists should know?

Objective: To review the evidence in literature regarding the occurrence of Chronic Kidney Disease (CKD) after the treatment of small renal tumors with either radical nephrectomy (RN) or partial nephrectomy (PN). Materials and Methods: Current literature reviewed using Mediline search regarding renal functional outcomes following surgical treatment of small renal tumours. Results: Studies have clearly shown that RN leads to CKD more often than PN and RN remains an independent risk factor for patients developing new onset renal insufficiency. There is independent, graded association between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization. PN achieves a better Health Related Quality Of Life due to better preservation of renal function. Radical nephrectomy is significantly associated with death from any cause compared with partial nephrectomy. Conclusion: Removal of entire kidney is definitely an over-treatment for small renal tumors and PN should be the standard of care for these small renal tumors even in the setting of a normal contralateral kidney.