Kidney Disease

Patients with poor kidney function.

Since any intervention on the kidney can cause further deterioration of kidney function, these patients may be better off selecting active surveillance. In some patients, further decline in kidney function puts the patient at risk of needing dialysis. Dialysis, while lifesaving, may be associated with poor outcomes and a low quality of life. Ask your doctor about your creatinine level, which is an indicator of kidney function (normal is less than 1.5 mg/dl).

No Dialysis

• No Transplant
• Acute Kidney Disease
• CKD- slowly progressive problem in the kidney
• Nephrotic syndrome
• Polycystic Kidney Disease
• Patients with hereditary forms of kidney cancer. This includes patients with Von-Hippel-Lindau (VHL), Birt-Hogg-Dube (BHD) or other conditions in which patients are at risk of having multiple tumors on both sides. These tumors are typically placed on active surveillance until they reach 3 centimeters or larger.
• Patients who have drug-eluting heart stents and need to be on a blood thinner. Kidney surgery/intervention can result in severe bleeding in these patients, and thus a period of active surveillance until they can come off the blood thinners may be helpful to avoid potentially serious complications.
• Elderly patients who are medically fragile. Since the risk that the small kidney tumor spreads is low, in patients with a short life expectancy (less than 10 years) a discussion regarding active surveillance may be prudent. Many of these patients die with the kidney tumor rather than from the kidney tumor.
• Patients who are experiencing or recovering from an active serious medical problem. A period of active surveillance until things stabilize should be entertained.
• Patients who are extremely anxious about having surgery or do not wish to have treatment.

What are the so-called triggers for intervention?

The most common trigger for intervention is demonstrated tumor growth. As a tumor gets larger, the risk of having a cancer and a more aggressive cancer increases. The risk of spread for a tumor less than 2 centimeters is less than 1%. The risk is 1–2% for 3-centimeter tumors and 3–5% for 4-centimeter tumors. Change in the patient condition could also trigger intervention. For example, a patient who was having a heart attack when their 2.5-centimeter kidney tumor was discovered has now recovered one year later and is fit for surgery. This now triggers an intervention.