Endoscopic management offers renal-sparing approaches for upper tract urothelial carcinoma (UTUC). We sought to characterize the impact of endoscopically managing UTUC on kidney function and identify predictors of renal function decline.
We queried a multi-institutional cohort of endoscopically managed UTUC. Estimated glomerular filtration rate values 12 months after endoscopic treatment were assigned according to the National Kidney Function Kidney Disease Outcomes Quality Initiative (KDOQI) chronic kidney disease (CKD) stages. Loss of kidney function was defined as an increase by at least one CKD stage. Severe loss was defined as an increase by at least 2 CKD stages or development of CKD stage 3b-5.
A total of 339 patients (521 interventions) were included. 113 patients (33.3%) experienced loss of kidney function and 75 (22.1%) experienced severe loss of kidney function. In multivariable logistic regression, high grade tumor (OR 2.29, 95% CI 1.23-4.33) and renal pelvic location (OR: 2.64, 95% CI 1.32-5.54) were significantly associated with loss of kidney function on a per-patient level. We observed similar results on a per-intervention analysis, with higher odds for kidney function loss for high grade tumor (OR 2.03, 95% CI 1.23-3.35) and renal pelvic location (OR 1.76, 95% CI 1.01-3.08).
Despite preservation of the renal unit, one-third of patients undergoing endoscopic management of UTUC experience loss of kidney function. High-grade tumors and renal pelvic location were associated with adverse renal function outcomes.
World journal of urology. 2026 May 22*** epublish ***
Philipp Korn, Mark Essien, Maximilian Pallauf, Joseph Cheaib, Soum Lokeshwar, Jaime O Herrera-Caceres, Alexander Small, Dima Raskolnikov, Nir Kleinmann, Asaf Shvero, Surena F Matin, Craig Labbate, Hristos Kaimakliotis, Isamu Tachibana, Jennifer Linehan, Jane Choe, Ojas Shah, Miyad Movassaghi, William Huang, Jesse Persily, Aaron Perecman, David Canes, Rodrigo R Pessoa, Aaron Potretzke, Jay D Raman, Nirmish Singla
Department of Urology, The Brady Urological Institute at Johns Hopkins, Johns Hopkins School of Medicine, 600 N. Wolfe Street/Park 213, Baltimore, MD, 21287, USA., Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA., Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA., Department of Urology, Sheba Medical Center, Ramat Gan, Israel., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Indiana University Medical Center, Indianapolis, IN, USA., Department of Urology, Providence Specialty Medical Group, Santa Monica, CA, USA., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA., Department of Urology, New York University Grossman School of Medicine, New York, NY, USA., Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA., Department of Urology, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, The Brady Urological Institute at Johns Hopkins, Johns Hopkins School of Medicine, 600 N. Wolfe Street/Park 213, Baltimore, MD, 21287, USA. .