The Influence of Surgical Approach to the Renal Mass on Renal Function

The National Kidney Foundation estimates that 26 million Americans are living with chronic kidney disease (CKD). The high prevalence of obesity, heart disease, hypertension, and diabetes places millions more at risk for developing CKD. When counseling patients with a newly diagnosed renal mass, treatment effect on renal function should always bea central part of the discussion. Although long-term sufficient renal function is routine in screened kidney donors, CKD is present in more than 30% of patients with a newly diagnosed renal mass and develops in most patients who undergo radical nephrectomy (RN) and a portion of those who undergo nephron-sparing approaches. Although radical surgery for kidney cancer can cure one disease (cancer), it can often lead to another (CKD) that may be just as concerning. The average 60-year-old patient can expect to live another 21 years, whereas a 60-year-old person on dialysis has an average of only 4.6 years left to live. However, the negative impact of decreasing renal function begins in patients long before they require renal replacement therapy. Patients with moderate to severe CKD (glomerular filtration rates [GFRs], 15–60 mL/min/1.73 m) have dose-related increases in cardiovascular events. Routinely, the assessment of renal function has relied on whether the serum creatinine