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Rosenzweig B, Recabal P, Gluck C, Coleman JA, Susztak K, Hakimi AA, Jaimes EA, Weiss RH. Can kidney parenchyma metabolites serve as prognostic biomarkers for long-term kidney function after nephrectomy for renal cell carcinoma? A preliminary study. Clin Kidney J 2021; 14:656-664. [PMID: 35261758 PMCID: PMC8894921 DOI: 10.1093/ckj/sfaa185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Nephrectomy, the standard of care for localized renal cell carcinoma (RCC), may lead to kidney function loss. Our goal was to identify prognostic biomarkers of postoperative renal function using metabolomics. Methods Metabolomics data from benign kidney parenchyma were collected prospectively from 138 patients with RCC who underwent nephrectomy at a single institution. The primary endpoint was the difference between the postoperative and preoperative estimated glomerular filtration (eGFR) rate divided by the elapsed time (eGFR slope). eGFR slope was calculated ∼2 years post-nephrectomy (GFR1), and at last follow-up (GFR2). A multivariate regularized regression model identified clinical characteristics and abundance of metabolites in baseline benign kidney parenchyma that were significantly associated with eGFR slope. Findings were validated by associating gene expression data with eGFR slope in an independent cohort (n = 58). Results Data were compiled on 78 patients (median age 62.6 years, 65.4% males). The mean follow-up was 25 ± 3.4 months for GFR1 and 69.5 ± 23.5 months for GFR2 and 17 (22%) and 32 (41%) patients showed eGFR recovery, respectively. Nephrectomy type, blood lipids, gender and 23 metabolites from benign parenchyma were significantly associated with eGFR slope. Some metabolites associated with eGFR slope overlapped with previously reported chronic kidney disease-related processes. Subgroup analysis identified unique ‘metabolite signatures’ by older age, nephrectomy type and preoperative eGFR. Conclusions Nephrectomy type, gender, blood lipids and benign parenchyma metabolites at nephrectomy were associated with long-term kidney function. On further study, these metabolites may be useful as potential biomarkers and to identify novel therapeutic targets for malignancy-associated renal disease.
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Affiliation(s)
- Barak Rosenzweig
- Department of Surgery, Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Pedro Recabal
- Department of Surgery, Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Urology Service, Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Caroline Gluck
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan A Coleman
- Department of Surgery, Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Katalin Susztak
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - A Ari Hakimi
- Department of Surgery, Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Edgar A Jaimes
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert H Weiss
- Department of Internal Medicine, Division of Nephrology, University of California, Davis, CA, USA
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Charytoniuk T, Małyszko M, Bączek J, Fiedorczuk P, Siedlaczek K, Małyszko J. Progression to chronic kidney disease in patients undergoing nephrectomy for small renal masses: a price to pay for a therapeutic success? Postgrad Med 2018; 130:613-620. [PMID: 30106608 DOI: 10.1080/00325481.2018.1511211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Nephrectomy, which constitutes a gold-standard procedure for the treatment of renal-cell carcinoma (RCC), has been widely discussed in the past decade as a significant risk factor of the development of chronic kidney disease (CKD). RCC is the third most common genitourinary cancer in the United States, with an estimated more than 65,000 new cases and 14,970 deaths. The aim of this review was to precisely and comprehensively summarize the status of current knowledge in CKD risk factors after nephrectomy, the advantages of minimally invasive vs. radical nephrectomy, post-nephrectomy biomarkers of CKD, ways of post-operative CKD prevention and, therefore, better understand why various aspects of CKD after nephrectomy. The majority of current studies indicated a better long-term kidney function preservation in patients undergoing partial nephrectomy in comparison to those after radical nephrectomy. Furthermore, a nephron-sparing surgery should be a preferred first-line procedure among young patients with small renal masses. As partial nephrectomy is followed by a greater risk of adverse outcomes relative to radical nephrectomy, a potential survival benefit should always be considered especially in the elderly or patients with comorbidities.
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Affiliation(s)
- Tomasz Charytoniuk
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland
| | - Maciej Małyszko
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland
| | - Jan Bączek
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland
| | - Piotr Fiedorczuk
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland
| | - Karolina Siedlaczek
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland
| | - Jolanta Małyszko
- a 2nd Department of Nephrology , Medical University of Bialystok , Bialystok , Poland.,b Department of Nephrology, Dialysis and Internal Medicine , Warsaw Medical University , Warsaw , Poland
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Rosenzweig B, Rubinstein ND, Reznik E, Shingarev R, Juluru K, Akin O, Hsieh JJ, Jaimes EA, Russo P, Susztak K, Coleman JA, Hakimi AA. Benign and tumor parenchyma metabolomic profiles affect compensatory renal growth in renal cell carcinoma surgical patients. PLoS One 2017; 12:e0180350. [PMID: 28727768 PMCID: PMC5519040 DOI: 10.1371/journal.pone.0180350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/14/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pre-operative kidney volume is an independent predictor of glomerular filtration rate in renal cell carcinoma patients. Compensatory renal growth (CRG) can ensue prior to nephrectomy in parallel to tumor growth and benign parenchyma loss. We aimed to test whether renal metabolite abundances significantly associate with CRG, suggesting a causative relationship. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Tissue metabolomics data from 49 patients, with a median age of 60 years, were previously collected and the pre-operative fold-change of their contra to ipsi-lateral benign kidney volume served as a surrogate for their CRG. Contra-lateral kidney volume fold-change within a 3.3 +/- 2.1 years follow-up interval was used as a surrogate for long-term CRG. Using a multivariable statistical model, we identified metabolites whose abundances significantly associate with CRG. RESULTS Our analysis found 13 metabolites in the benign (e.g. L-urobilin, Variable Influence in Projection, VIP, score = 3.02, adjusted p = 0.017) and 163 metabolites in the malignant (e.g. 3-indoxyl-sulfate, VIP score = 1.3, adjusted p = 0.044) tissues that significantly associate with CRG. Benign/tumor fold change in metabolite abundances revealed three additional metabolites with that significantly positively associate with CRG (e.g. p-cresol sulfate, VIP score = 2.945, adjusted p = 0.033). At the pathway level, we show that fatty-acid oxidation is highly enriched with metabolites whose benign tissue abundances strongly positively associate with CRG, both pre-operatively and long term, whereas in the tumor tissue significant enrichment of dipeptides and benzoate (positive association), glycolysis/gluconeogenesis, lysolipid and nucleotide sugar pentose (negative associations) sub-pathways, were observed. CONCLUSION These data suggest that specific biological processes in the benign as well as in the tumor parenchyma strongly influence compensatory renal growth.
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Affiliation(s)
- Barak Rosenzweig
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Nimrod D. Rubinstein
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Ed Reznik
- Computational and Systems Biology Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Roman Shingarev
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Krishna Juluru
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Oguz Akin
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - James J. Hsieh
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Edgar A. Jaimes
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Katalin Susztak
- Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jonathan A. Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail: (AAH); (JAC)
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail: (AAH); (JAC)
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