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Editorial Comment to Mercaptoacetyltriglycine‐3 renogram is not superior to estimated glomerular filtration rate measurement for the prediction of long‐term renal function after nephrectomy

Hiroshi Kanamaru et al. carried out preoperative renal scintigraphy in patients who underwent unilateral nephrectomy and investigated whether it is valuable for predicting the long-term renal function. They concluded that renal scintigraphy had less value than estimated glomerular filtration rate (eGFR). As the authors mentioned, the reason why preoperative eGFR predicted postoperative eGFR more effectively than contralateral effective renal plasma flow (cERPF) was simply because the renal function goal they used was not ERPF, but eGFR. The renal function on the resected side influences postoperative value. Meanwhile, compensatory hyperfunction occurs in the normal side before surgery, when the renal function on the resected side is disturbed by large tumors, therefore, it stands to reason that preoperative total eGFR has a correlation with postoperative eGFR. Still, if they investigate the relationship between preoperative eGFR ¥ cERPF/total ERPF (tERPF) and postoperative eGFR, it would be more predictable. From the results of this study (fig. 1f) and some previous studies, postoperative renal function after nephrectomy is approximately 60–80% of preoperative value. The merit in omitting scintigraphic evaluation is that it saves on costs and time, meanwhile, the differential renal function should be assessed accurately before nephrectomy, especially in patients who have low renal function, are scheduled for adjuvant chemotherapy/molecular targets and so on. Such patients are candidates for renal scintigraphy, or at least should be assessed using the recently reported formula for predicting postoperative renal function from preoperative computed tomography scan images.