MP7-15 SIMPLE PREDICTION OF POSTOPERATIVE RENAL FUNCTION WITH DYNAMIC CT BEFORE NEPHROURETERECTOMY: THE RATIO OF RENAL CORTEX ENHANCEMENT BETWEEN DISEASED AND CONTRALATERAL KIDNEY (2015)

You have accessJournal of UrologyBladder Cancer: Upper Tract TCC II1 Apr 2015MP7-15 SIMPLE PREDICTION OF POSTOPERATIVE RENAL FUNCTION WITH DYNAMIC CT BEFORE NEPHROURETERECTOMY: THE RATIO OF RENAL CORTEX ENHANCEMENT BETWEEN DISEASED AND CONTRALATERAL KIDNEY Yuma Waseda, Yudai Ishikawa, Keizou Kawano, Kazunori Kihara, and Shinji Morimoto Yuma WasedaYuma Waseda More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Keizou KawanoKeizou Kawano More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Shinji MorimotoShinji Morimoto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.222AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Precise prediction of perioperative change in renal function would lead to appropriate patient selection for perioperative cisplatin-based combination chemotherapy in advanced upper tract urothelial carcinoma (UTUC) patients. The renal cortex enhancement in CT could reflect renal function. The aim of this study is to evaluate usefulness of the ratio of renal cortex enhancement between diseased and contralateral kidney in preoperative dynamic CT for the prediction of postoperative renal function. METHODS Among 70 patients who were evaluated by dynamic CT before NU from 2002 to 2014, 56 patients whose preoperative estimated glomerular filtration rate (eGFR) was over 60 ml/min/1.73m2 were subject of this study. To measure the renal cortex enhancement, Hounsfield unit (HU) were obtained from a round region of interest placed over the highest enhancing area on corticomedullary images in dynamic CT. A ratio of HU between diseased and contralateral kidney was calculated and termed the diseased/contralateral enhancement ratio (DCER). Predictive factors for new onset of chronic kidney disease (CKD) (eGFR ≤ 60) were identified and the calculation formula for postoperative eGFR using DCER was developed. RESULTS Median DCER was 85%. Lower DCER was associated with the presence of hydronephrosis (p < 0.001). Among 56 patients with pre-eGFR > 60, 20 patients (36%) developed new onset of CKD after NU. In univariate analysis, higher DCER > 85% and patient age ≥ 70 years were associated with new onset of CKD, but not hydronephrosis (p = 0.068). Multivariate analysis demonstrated that DCER > 85% (HR6.85, p = 0.007) and patient age ≥ 70 (HR3.69, p = 0.044) were both independent risk factors for new onset of CKD. A linear regression was used to determine a conversion factor between DCER and postoperative decrease rate of eGFR. From the conversion factors, predictive formula was developed; post-eGFR = pre-eGFR × (0.75 × DCER - 0.37). The correlations of calculated and actual post-eGFR were feasible (R2 = 0.623, p < 0.001). CONCLUSIONS The ratio of renal cortex enhancement is a significant predictor for postoperative change of eGFR in UTUC patients treated by NU. That could be useful in real practice due to its objective quantifiability with simple measurement. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e69 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda More articles by this author Yudai Ishikawa More articles by this author Keizou Kawano More articles by this author Kazunori Kihara More articles by this author Shinji Morimoto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...