From the Guidelines
After a kidney removal for renal cancer, follow-up should be tailored to the individual's risk of recurrence, with a recommended schedule outlined in Table 2 of the 2021 AUA guideline, which includes visits and imaging studies at 3,6,9,12,18,24,30,36,48,60,72-84, and 96-120 months for high-risk patients. The follow-up plan should be individualized based on patient requirements and may be extended beyond 5 years at the discretion of the physician 1. Patients should expect clinic visits to include physical examinations, blood tests to check kidney function, and imaging studies such as CT scans or ultrasounds of the remaining kidney and previously affected area.
Key Components of Follow-up
- Physical examinations to monitor for signs of recurrence or complications
- Blood tests, including creatinine, BUN, and GFR, to check kidney function 1
- Imaging studies, such as CT scans or ultrasounds, to monitor the remaining kidney and previously affected area
- Urinalysis to check for blood or protein in urine
- Blood pressure monitoring to detect potential hypertension due to the increased workload on the remaining kidney
Lifestyle Recommendations
- Maintain adequate hydration, about 2 liters of fluid daily
- Follow a kidney-friendly diet that is lower in salt
- Avoid nephrotoxic medications like NSAIDs (ibuprofen, naproxen)
- Regular exercise and maintaining a healthy weight to support overall recovery and kidney health
Reporting Symptoms
Patients should promptly report any symptoms like flank pain, blood in urine, unexplained weight loss, or persistent fatigue to their healthcare provider, as these could indicate recurrence or complications 1. This comprehensive follow-up approach helps detect any cancer recurrence early while ensuring the remaining kidney functions optimally.
From the Research
Follow-up after Nephrectomy for Renal Cell Carcinoma
- The follow-up strategies after nephrectomy for renal cell carcinoma are designed to detect local recurrence or metastatic disease and allow for appropriate treatment 2.
- Most surveillance protocols recommend various follow-up strategies for all tumor stages, with an emphasis on follow-up during the first 3-5 years after nephrectomy 2.
- The investigations used for follow-up typically include symptom enquiry, physical examination, chest x-ray, and computed tomography scanning, although there is no consensus on which investigations should be performed and at what intervals 2.
Post-Nephrectomy Care
- Patients who undergo partial or radical nephrectomy for renal cell carcinoma may experience blood loss and require transfusions, with the risk of greater blood loss and subsequent need for transfusion being higher in patients with advanced disease 3.
- Preoperative autologous blood donation may have limited value in reducing the need for transfusions, but preoperative erythropoietin administration may be a viable option for patients at high risk of blood loss 3.
Prognostic Factors
- Inflammatory markers such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI) have been shown to be prognostic for cancer-specific survival and overall survival in patients with localized renal cell carcinoma treated with nephrectomy 4, 5.
- Other prognostic factors for survival in patients with renal cell carcinoma include tumor stage, grade, and age 4.
Treatment Options for Metastatic Disease
- Cytoreductive nephrectomy may be considered for patients with metastatic renal cell carcinoma, as it has been shown to extend survival by approximately 50% for many patients 6.
- Patient selection is crucial when considering cytoreductive nephrectomy, taking into account performance status and sites and burden of disease 6.