Martini et al reported a nomogram for predicting a significant reduction in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from Icahn School of Medicine at Mount Sinai, OhioHealth Dublin Methodist Hospital (Columbus), Temple University, Columbia University, Wake Forest School of Medicine and Swedish Urology Group (Seattle).
Patient selection: robotic partial nephrectomy, age 25 to 85 years
Outcome: >=25% reduction of eGFR from baseline from 3 to 15 months after surgery
Parameters:
(1) age in years
(2) gender
(3) Charlson Comorbidity Index (CCI)
(4) RENAL score of Kutikov and Uzzo
(5) baseline eGFR
(6) acute kidney injury
points for age =
= (0.083333 * (age)) + 0.0166667
points for RENAL score from 4 to 12 =
= (0.625 * (RENAL))
points for baseline eGFR from 15 to 135 =
= (0.07416667 * (GFR)) - 0.0125
|
Parameter
|
Finding
|
Points
|
|
gender
|
male
|
0
|
|
|
female
|
3.1
|
|
CCI
|
0
|
0
|
|
|
1
|
2.5
|
|
|
2
|
3.6
|
|
|
3
|
4.1
|
|
|
>=4
|
8.3
|
|
acute kidney injury
|
no
|
0
|
|
|
without CKD
|
8.5
|
|
|
with CKD
|
8.9
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 5.7
• maximum score: 44.9
• The higher the score the greater the risk of a decrease in eGFR.
probability of a significant reduction of eGFR between 3 and 15 months after surgery =
= (0.00028707 * ((score)^3)) - (0.013966 * ((score)*2)) + (0.37695 * (score)) - 6.0272
