Renal disease and African-Americans

UroToday:

Recent studies have suggested that nephron sparing surgery is significantly underutilized as a treatment approach, and that radical nephrectomy for renal cell carcinoma (RCC) is associated with a significantly increased risk of renal insufficiency. Race also plays a role in the development of renal disease and it is of significant note that African Americans (AA) have shown an increase in both the incidence and mortality from RCC. AA race is associated with an increased incidence of risk factors associated with the development of renal insufficiency such as hypertension, diabetes mellitus, and obesity. Further, the incidence of end stage renal disease requiring renal replacement is higher in African Americans. Here, the role of race as a risk factor for the development of renal insufficiency following radical nephrectomy for RCC is examined.

In this retrospective study, 22 AA patients undergoing radical nephrectomy were compared to 19 non-AA patients. Mean tumor size for both groups was 8.1 cm (range 3-25). During the time of the study, 6 patients were excluded from analysis; 3 were on dialysis, 2 with creatinine greater than 2.0 at baseline, and 1 who had a renal transplant. The mean preoperative creatinine for the AA patients was 1.3, which was not significantly different from the mean preoperative creatinine of the non-AA patients (1.1, p=0.07). Following radical nephrectomy, the mean postoperative creatinine for AA patients (1.7) was significantly higher than the mean postoperative creatinine for non-AA patients (1.3, p=0.004). In a subset analysis, the authors found that the mean postoperative creatinine was significantly higher for AA patients with hypertension (2.0) when compared with non-AA patients with hypertension (1.4, p=0.002), but there was no difference in postoperative creatinine between AA's and non-AA's that were normotensive (p=0.09).

This study, while composed of very small numbers of patients, highlights the fact that radical nephrectomy can be associated with significant renal morbidity, and this may particularly be amplified in patients of AA descent. When appropriate and feasible, nephron sparing approaches should be utilized to maximize nephron mass while maintaining oncologic control.

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