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Partial Nephrectomy in Solitary Kidneys: Intraoperative Techniques and Their Impact on Chronic Kidney Disease Progression
by
, , , ,
Benjamin N. Schmeusser
1,*
,
Courtney Yong
1,
Daniel Sidhom
1,
Edouard H. Nicaise
2,
Reza Lahiji
3,
James E. Slaven
4,
Dattatraya H. Patil
3,
Kenneth Ogan
3,
Chandru Sundaram
1,
Viraj A. Master
3 and
Ronald S. Boris
1 1
Department of Urology, School of Medicine, Indiana University, 535 Barnhill Drive|RT 150, Indianapolis, IN 46202, USA
2
Department of Urology, Lenox Hill Hospital, New York, NY 10075, USA
3
Department of Urology, Emory University, Atlanta, GA 30322, USA
4
Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN 46202, USA
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(10), 1644; https://doi.org/10.3390/cancers18101644
Submission received: 11 April 2026
/
Revised: 9 May 2026
/
Accepted: 17 May 2026
/
Published: 19 May 2026
(This article belongs to the Special Issue Advances in Renal Cell Carcinoma)
Simple Summary
A kidney tumor in a patient with only one functioning kidney is a unique surgical challenge. The tumor must be removed while preserving healthy kidney tissue to avoid dialysis. Partial nephrectomy is preferred because it removes only the tumor and as little surrounding tissue as possible. However, it is unclear if specific surgical techniques influence the long-term kidney function of these patients. This study considers over 100 patients at two major medical centers that underwent partial nephrectomy on a solitary kidney. The techniques used in the operating room, such as blood flow interruption method, amount of tissue removed, and closure technique, and the impact on kidney function were considered. These findings suggest that partial nephrectomy in solitary kidneys can achieve favorable renal functional outcomes with appropriate patient selection and sound surgical technique, but future study of certain techniques, such as the use of ice in the surgery, is warranted.
Abstract
Objective: Solitary kidney tumors are a challenging scenario necessitating both oncologic efficacy and renal function preservation. Partial nephrectomy (PN), when feasible, remains the gold standard for management. We examine intraoperative techniques and their association with renal function decline in patients with solitary kidneys undergoing PN. Methods: In two high volume academic referral centers, we analyzed patients that underwent PN in a solitary kidney from 2000 to 2023. Patient characteristics, tumor details, and operative details were obtained. Chronic kidney disease (CKD) upstaging from pre- to postoperative was the primary outcome, with multivariable analysis examining the association between intraoperative factors and CKD progression. Results: In total, 104 patients were included, of which 38 (36.5%) experienced CKD upstaging. Mean eGFR decline was 15.4% at median follow-up of 16 months. Cold ischemia was associated with higher odds of CKD upstaging compared to warm ischemia (OR 3.64; 95% CI 1.06–12.52) and no ischemia (4.55; 95% CI 1.09). Notably, cold ischemia cases tended to involve significantly larger, more complex tumors in patients with lower baseline renal function. Ischemia time, parenchyma resection, renal volume change, operative time, and renorrhaphy type were not predictors of CKD upstaging. Conclusions: PN in solitary kidneys remains standard with evidence of excellent renal preservation in this cohort. Worse outcomes were observed with cold ischemia, although this more likely represents underlying tumor complexity with other uncontrollable factors; however, this should be explored further. These findings suggest that renal functional outcomes are likely reasonable in patients with solitary kidneys undergoing PN when appropriate patient selection and sound surgical technique are utilized.
