Estimated blood loss to urine output ratio during partial nephrectomy as a predictor of postoperative acute kidney injury in a hereditary renal cancer-enriched population

Authors

  • Lauren Loebach National Cancer Intitute
  • Ruben Blachman-Braun National Cancer Intitute
  • Milan H. Patel National Cancer Intitute
  • Braden Millan National Cancer Intitute
  • Maria Antony National Cancer Intitute
  • Julie Solomon National Cancer Institute
  • Jaskirat Saini National Cancer Institute
  • Sandeep Gurram National Cancer Institute
  • W. Marston Linehan National Cancer Institute
  • Mark W. Ball National Cancer Institute

DOI:

https://doi.org/10.5489/cuaj.9290

Keywords:

Estimated blood loss, urine output, acute kidney injury, partial nephrectomy

Abstract

INTRODUCTION: We aimed to assess whether the intraoperative estimated blood loss (EBL) to urine output (UOP) ratio is a predictor of postoperative acute kidney injury (AKI) in a cohort of patients enriched with hereditary renal cancer syndromes undergoing partial nephrectomy (PN).

METHODS: We performed a retrospective chart review of patients who underwent PN at our institution from January 2006 to October 2024. We recorded and analyzed the clinical, demographic, and intraoperative characteristics of all patients.

RESULTS: A total of 1166 PNs (761 patients and 5903 renal tumors) were analyzed, of which 484 (41.5%) developed postoperative AKI. The average EBL/UOP was 1.06 (0.46- 2.35) for patients without AKI and increased as AKI worsened, with a ratio of 5.00 (2.34- 9.43) in patients with KDIGO AKI grade 3 (p<0.001). EBL/UOP was associated with AKI in all patients (odds ratio [OR] 1.079, p=0.002) and those with bilateral native kidneys (OR 1.083, p=0.003). After adjustment in patients with a solitary kidney, no AKI association with EBL/UOP (OR 1.039, p=0.447) was found.

CONCLUSIONS: EBL/UOP is a novel tool associated with the increased risk of developing post-PN AKI in select patients. In multiplex and repeat PNs, a higher ratio can assist the surgical team in identifying patients at risk of developing AKI. Prospective evaluation involving management strategies based on the EBL/UOP is needed to determine its true utility in clinical practice and generalization in the broader PN population.

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Published

2025-09-23

How to Cite

Loebach, L., Blachman-Braun, R., Patel, M. H., Millan, B., Antony, M., Solomon, J., … Ball, M. W. (2025). Estimated blood loss to urine output ratio during partial nephrectomy as a predictor of postoperative acute kidney injury in a hereditary renal cancer-enriched population. Canadian Urological Association Journal, 20(1), E35–43. https://doi.org/10.5489/cuaj.9290

Issue

Vol. 20 No. 1 (2026): CUAJ January

Section

Original Research

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