Sumi Dey

Prevalence of Proteinuria and Other Abnormalities in Urinalysis Performed in the Urology Clinic

OBJECTIVE To compare the prevalence of proteinuria in the urology clinic with other outpatient settings. Chronic kidney disease is classified according to cause, glomerular filtration rate, and proteinuria. Proteinuria may be more prevalent in patients with known chronic kidney disease, renal disorders (benign or malignant), or after urologic surgery. METHODS A cross-sectional study of 3 populations undergoing urinalysis (UA) testing was carried out: general outpatients (n = 20,334), urology outpatients (n = 5023), and kidney cancer patients (n = 1016). Proteinuria was classified under Kidney Disease: Improving Global Outcomes guidelines: A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). RESULTS Proteinuria was detected throughout a community-based health system in 8.6% of UA (8.2%: A2; 0.4%: A3). In comparison, 18.6% of urology office-performed UA had proteinuria (16.0%: A2, 2.5%: A3) (P < .0001 vs non-urology). Kidney cancer patients were more likely to have proteinuria (17.9%: A2, 3.8%: A3). The proportion with A3 was significantly higher in urology and kidney cancer patients when compared with other outpatients (each P < .0001), and in the kidney cancer subgroup compared with all urology patients (P < .0001). Additional abnormalities were frequently present on microscopic analysis of UA in the urology clinic, including hematuria (20.9%), pyuria (21.8%), and bacteriuria (3.1%). CONCLUSION The value of UA in the urology clinic as a screening test for proteinuria and other conditions appears high, with >56% having at least 1 abnormality. The population risk of proteinuria in the urology clinic is 18.5%, which is higher than that observed in non-urology clinics. Patients with kidney cancer appear more likely to have proteinuria than the average urology patient. We recommend evaluation of urology patients with UA to identify proteinuria.

Chronic Kidney Disease Is More Common in Locally Advanced Renal Cell Carcinoma

OBJECTIVE To retrospectively evaluate clinical predictors of chronic kidney disease (CKD) in renal cell carcinoma (RCC) patients to identify associations between patient- and tumor-specific factors with poorer renal function. CKD and RCC are interrelated, with 26%-44% of RCC patients having concomitant CKD at diagnosis. PATIENTS AND METHODS Institutional registries from Spectrum Health and University of California, San Diego, were queried for preoperative glomerular filtration rate and proteinuria status before radical or partial nephrectomy. Preoperative clinical and tumor factors were recorded; proteinuria was classified as A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). CKD was grouped by Kidney Disease Improving Global Outcomes classification (low, moderately increased, high, very high). RESULTS We evaluated 1569 patients undergoing surgery for renal cortical tumors. CKD status was low risk in 860 (55%), moderately increased in 381 (24%), high in 194 (12%), and very high in 134 (9%) patients. Increased radius, exophytic or endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior or posterior, location relative to polar lines score, tumor size, and clinical tumor stage were strongly associated with increased CKD risk at baseline. Clinical stage T3/T4 disease had more at-risk patients than stages T2 and T1 disease (39.5% vs 22% and 19%, P = .0001). Clinical tumor stage and gender were the only predictors of proteinuria, lower glomerular filtration rate, and higher CKD risk group in both univariate and multivariate analyses. CONCLUSION Forty-five percent of patients with RCC had moderate or higher CKD before treatment. A positive correlation between pretreatment CKD and locally advanced RCC (cT3/T4) was present. This likely relates to increased loss of functional parenchyma with increasing tumor size or stage, with important implications in patient management.

Renal Functional Outcome of Partial Nephrectomy for Complex R.E.N.A.L. Score Tumors With or Without Neoadjuvant Sunitinib: A Multicenter Analysis

Background Sunitinib might optimize the feasibility of partial nephrectomy (PN) for complex renal tumors with imperative indications. We compared the renal functional outcomes of patients with complex renal masses who had undergone sunitinib before PN with those of patients who had not required neoadjuvant sunitinib before PN. Patients and Methods We performed a multicenter retrospective analysis of patients with renal cell carcinoma who had undergone PN for a complex renal mass (R.E.N.A.L. nephrometry score, 10‐12) and imperative indications from January 2012 to July 2014. Neoadjuvant sunitinib was used in cases for which PN was not considered feasible. The cohort was divided into those patients who had undergone PN without neoadjuvant sunitinib and those who had undergone PN after sunitinib (no‐neoadjuvant vs. neoadjuvant). The change in tumor size and R.E.N.A.L. score were assessed. The primary outcome was the change in the estimated glomerular filtration rate (&Dgr;eGFR) from preoperatively to the last postoperative follow‐up visit. Results The data from 125 consecutive patients were analyzed (47 neoadjuvant and 78 no‐neoadjuvant; median follow‐up, 21 months). The neoadjuvant plus PN patients had had a greater median tumor size preoperatively (7.2 vs. 6 cm; P = .045). Sunitinib caused a significant decrease in the median tumor size (from 7.2 to 5.8 cm [19.4%]; P = .012) and R.E.N.A.L. score (from 11 to 9; P = .001). No significant differences were found between the neoadjuvant and no‐neoadjuvant groups in the ischemia time (P = .413) or incidence of complications (P = .728). The median &Dgr;eGFR was similar (neoadjuvant, 6.4; no‐neoadjuvant, 6.1; P = .534). Linear regression analysis for factors associated with an increasing &Dgr;eGFR demonstrated increasing age (estimate, −0.074; P = .009) increasing body mass index (estimate, −0.087; P = .043), and decreasing baseline eGFR (estimate, −0.104; P = .02) as significant factors. Conclusion The use of neoadjuvant sunitinib might facilitate complex PN and result in renal functional outcomes similar to those of patients with a complex renal mass who had not required neoadjuvant sunitinib. Micro‐Abstract Neoadjuvant sunitinib might facilitate partial nephrectomy (PN) in imperative indications. We performed a retrospective comparison of functional outcomes in patients who had and had not received neoadjuvant sunitinib before PN for imperative indications. We noted similar renal functional outcomes between the 2 groups. To the best of our knowledge, these findings represent the first such reported comparison.

Neoadjuvant Targeted Molecular Therapy Before Renal Surgery.

Neoadjuvant targeted molecular therapy may benefit select patients with metastatic renal cell carcinoma. The primary use of this therapy in patients with metastatic disease is to reduce tumor burden, prevent distant metastasis, and increase overall survival. Neoadjuvant therapy may reduce tumor size and tumor complexity, facilitate partial nephrectomy rather than radical nephrectomy, downstage tumor thrombus facilitating thrombectomy, and make unresectable tumors resectable when applied to selected patients. These potential benefits of neoadjuvant therapy require further clinical trials to better define the renal function and oncological and survival outcomes in patients receiving each active agent.

MP67-07 PATHOLOGICAL DETERMINANTS OF ONCOLOGIC OUTCOMES IN STAGE II RENAL CELL CARCINOMA: AN INTERNATIONAL MULTICENTER ANALYSIS

bilateral kidneys with single eAML on the left). Only one patient suffered from spontaneous haemorrhage. Two cases developed distant metastasis: one had nodules over bilateral lungs and left anterior mediastinum; the other had recurrence over liver and retroperitoneum one year after surgical intervention. Three cases had venous thrombus (two in renal vein and one in inferior vena cava) and received thrombectomy. All 21 cases received surgical intervention: 13 radical nephrectomy, 7 partial nephrectomy, one was found with retroperitoneal eAML arising from renal capsule thus undergone tumor excision without kidney involvement. The follow up period ranges from 1 to 143 months (average 51 months). Only 2 cases died from unrelated cause. CONCLUSIONS: In our study, the rate of aggressive behavior is 24% (2 distant metastasis and 3 venous invasion in the 21 cases). Some noticeable accompanying characteristics including haemorrhage, coexisting with AML, coexisting with renal cell carcinoma are also seen in this series. The incidence of renal vein and inferior vena cava thrombus formation in our series is high (3 out of 21), therefore, detailed preoperative image evaluation is necessary.

MP72-03 COMPARATIVE ANALYSIS OF RADICAL AND PARTIAL NEPHRECTOMY IN PATIENTS WITH PREOPERATIVE STAGE 2 CHRONIC KIDNEY DISEASE: A MULTICENTER STUDY

Zachary Hamilton*, San Diego, CA; Alessandro Larcher, Milan, Italy; Brian Lane, Grand Rapids, MI; Umberto Capitanio, Milan, Italy; Sumi Dey, Grand Rapids, MI; Aaron Bloch, Charles Field, San Diego, CA; Samer Kirmiz, Grand Rapids, MI; Daniel Han, San Diego, CA; Adam Bezinque, Grand Rapids, MI; Alp Tuna Beksac, San Diego, CA; Cristina Carenzi, Milan, Italy; Fang Wan, James Proudfoot, San Diego, CA; Francesco Montorsi, Milan, Italy; Ithaar Derweesh, San Diego, CA