Degree of contrast enhancement improves prediction of new baseline glomerular filtration rate following radical nephrectomy

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Objectives To assess the accuracy of PVA+, a model integrating differential degree of enhancement (DOE) with parenchymal volume analysis (PVA), for predicting new baseline glomerular filtration rate (NBGFR) following radical nephrectomy (RN), and to assess PVA+ vs PVA alone in patients with hydronephrosis, where disruptions in the parenchymal volume/function relationship may impact prediction accuracy. Patients and Methods A total of 485 RN patients (2006–2021) with preoperative contrast‐enhanced computed tomography were included. The predicted NBGFR was estimated to be 1.25 (GFRpreRN x split renal function [SRF]contralateral), with 1.25 representing the average renal functional compensation following RN in adults. For PVA, SRF was determined with differential parenchymal volumes, whereas for PVA+ the differential DOE was also incorporated. Parenchymal volumes and DOE were measured using semi‐automated software from the venous phase vs non‐contrast images. The accuracy of predicted vs observed NBGFR was compared using a 15% threshold. Results Overall, PVA+ accurately predicted NBGFR for 76% (r = 0.86) of the cases, compared to 72% for PVA alone (r = 0.84, both P < 0.05). PVA+ was particularly advantageous in patients with hydronephrosis or renal vein thrombosis (RVT; 68% vs 50% accuracy for PVA+ vs PVA alone; P < 0.01). Similarly, PVA+ was superior in patients with infiltrative renal masses (IRMs) compared to PVA alone (55% vs 40%; P < 0.01). Conclusion Accurate prediction of NBGFR following RN is essential for counselling patients for whom RN is being considered vs partial nephrectomy. PVA+ was superior to PVA alone for NBGFR prediction, particularly in patients with hydronephrosis, RVT and IRMs. Requiring only routine contrast‐enhanced preoperative imaging, PVA+ improves peri‐operative decision‐making for patients with localised renal masses, particularly in cases where the parenchymal volume/function relationship might be distorted.

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