Maximal kidney length predicts need for native nephrectomy in ADPCKD patients undergoing renal transplantation


  • Octav Cristea
  • Daniel Yanko
  • Sarah Felbel
  • Andrew House
  • Alp Sener
  • Patrick P.W. Luke lhsc



Nephrectomy, Renal Transplantation, Polycystic Kidney Disease, Kidney Length


Introduction: Native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is performed on a case-by-case basis. We determine if pre-transplant maximal kidney length (MKL) can be used to predict ultimate nephrectomy status.

Methods: We performed a retrospective review of ADPKD patients who underwent renal transplantation at our centre between January2000 and December 2012. Pre-transplant measurements of MKL alone, MKL adjusted for height (HtMKL), weight (WtMKL) and body mass index (BMI-MKL) were each assessed for their predictive ability via a receiver operating characteristic (ROC) curve analysis.

Results: In total, 84 patients met our inclusion criteria, of which17 (20.2%) underwent native nephrectomy. An MKL ROC curve analysis revealed an area under the curve (AUC) of 0.867 (95% confidence interval [CI] 0.775–0.931; p < 0.001). An optimal cut-off criterion of >21.5 cm revealed a sensitivity of 94.1% (95% CI 71.3–99.9) and specificity of 70.1% (95% CI 57.7–80.7) for eventual nephrectomy. The AUC of HtMKL, WtMKL and BMI-MKL ROC curves did not differ significantly from MKL alone. HtMKL improved specificity, but not overall test performance. The determination of the cut-off MKL may be influenced by the single-centre retrospective nature of this analysis, as well as the fact that renal size was determined by ultrasound and not computerized tomography or magnetic resonance imaging.

Conclusion: MKL in patients with ADPKD is associated with the eventual need for nephrectomy and may be a useful clinical tool to risk stratify these patients and therefore guide patient conversations to a decision to leave the native kidneys in situ.


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Author Biography

Patrick P.W. Luke, lhsc

Professor of Surgery





How to Cite

Cristea, O., Yanko, D., Felbel, S., House, A., Sener, A., & Luke, P. P. (2014). Maximal kidney length predicts need for native nephrectomy in ADPCKD patients undergoing renal transplantation. Canadian Urological Association Journal, 8(7-8), 278–82.



Original Research