Severity of Preoperative Proteinuria is a Risk Factor for Overall Mortality in Patients Undergoing Nephrectomy

David Y. Yang, R. Houston Thompson, Harras B. Zaid, Christine M. Lohse, Andrew D. Rule, Stephen A. Boorjian, Bradley C. Leibovich, John C. Cheville, Matthew K. Tollefson

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Purpose Chronic kidney disease may adversely affect survival following nephrectomy. Proteinuria is increasingly used as a marker of kidney disease. However, the relationship between preoperative proteinuria and survival after nephrectomy remains incompletely characterized. We evaluated the association of preoperative proteinuria with overall and cancer specific survival using our institutional nephrectomy registry. Materials and Methods We identified 1,846 patients with localized clear cell renal cell carcinoma treated with curative intent (radical or partial nephrectomy) between 1995 and 2010. Patients were categorized for analysis based on preoperative proteinuria severity (mild, moderate or severe). Overall and cancer specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to assess for variables associated with overall and cancer specific mortality. Results Preoperative urine protein testing was available in 1,347 patients (73%). A total of 804 patients (60%) were classified with mild proteinuria (less than 150 mg per day), 332 (25%) were classified with moderate proteinuria (150 to 500 mg per day) and 211 (16%) were classified with severe proteinuria (greater than 500 mg per day). On multivariable analysis with mild proteinuria as the reference category the adjusted HR for all cause mortality was 1.18 (95% CI 0.95–1.48, p = 0.14) for moderate proteinuria and 1.61 (95% CI 1.26–2.07, p <0.001) for severe proteinuria. However, the proteinuria level was not associated with cancer specific survival. Conclusions Severe preoperative proteinuria is associated with worse overall survival following radical or partial nephrectomy for localized clear cell renal cell carcinoma. Preoperative proteinuria should be evaluated in patients undergoing nephrectomy and considered when estimating overall patient health status.

Original languageEnglish (US)
Pages (from-to)795-802
Number of pages8
JournalJournal of Urology
Volume198
Issue number4
DOIs
StatePublished - Oct 2017

Keywords

  • carcinoma
  • kidney
  • mortality
  • nephrectomy
  • proteinuria
  • renal cell

ASJC Scopus subject areas

  • Urology

Fingerprint

Dive into the research topics of 'Severity of Preoperative Proteinuria is a Risk Factor for Overall Mortality in Patients Undergoing Nephrectomy'. Together they form a unique fingerprint.

Cite this