Clinical value of pathologic examination of non-neoplastic kidney in patients with upper urinary tract malignancies

Abstract

Background/Aims:While surgical resection remains the standard of care in the treatment of upper urinary tract malignancies, nephrectomy is a risk factor for the development of chronic kidney disease (CKD). The aim of this study was to determine whether histologic evaluation of non-neoplastic kidney could enable early identification of unrecognized kidney disease and could be of prognostic value in predicting postoperative renal outcomes.Methods:We retrospectively analyzed 51 patients with upper urinary tract malignancies who received uninephrectomy or uninephroureterectomy. A thorough pathologic evaluation of non-neoplastic kidney including special stains, immunofluorescence, and electron microscopic studies was performed. The degree of parenchymal changes was graded from 0 to 15.Results:Of 51 patients, only 13 showed normal kidney pathology. Fifteen patients showed glomerular abnormalities, 14 showed diabetic nephropathy, and 11 showed vascular nephropathy. There was one case each of reflux nephropathy and chronic pyelonephritis. The median histologic score was 5 points. Only 25.4% of patients had ≤ 3 points. Score more than 5 was observed in 47.1% of patients. Postoperative estimated glomerular filtration rate (eGFR) at 3 to 36 months were obtained from 90.2% of patients, and of those, 34.8% had de novo CKD. Since no one had CKD in partial nephrectomized patients, we determined risk factors for CKD in radical nephrectomized patients. Cox regression analysis revealed that postoperative AKI, preoperative eGFR, and histologic score of non-neoplastic kidney were the independent predictors for CKD.Conclusions:We conclude that routine pathologic evaluation of non-neoplastic kidney provides valuable diagnostic and prognostic information.

More than ancillary records: clinical implications of renal pathology examination in tumor nephrectomy specimens

“…Additional glomerular, tubulo-interstitial or vascular nonneoplastic diseases were observed distant from the putative tumor bed in 18.9% of our cases. This incidence is in line with most published data (15-29.4%), which depend, though, on their specific pathologic definition [6][7][8]11]. This frequency may seem high in comparison to the general population, but a substantial part of the lesions we described here are related to diabetes mellitus, hypertension, or TIN cases, disorders that are recognized risk factors for RCC.…”

Non-neoplastic Kidney Diseases in Adult Tumor Nephrectomy and Nephroureterectomy Specimens in a Southeast Asian Tertiary Medical Center

“…NNRD can be found in 9 to 38% of kidney and ureteral cancer patients (table 4) 6,9,12,[14][15][16][17][18][19][20][21][22] . Up to 90% of these diagnoses were not found at the initial pathologic evaluation, because pathologists focused on the renal neoplasm, and none of the patients in our cohort were initially diagnosed.…”

Morphological findings in frozen non-neoplastic kidney tissues of patients with kidney cancer from large-scale multicentric studies on renal cancer

“…It is shown that 5 to 25% of RCC patients have varying pathologies of chronic kidney disease and those with normal renal function are more likely to develop chronic kidney disease after nephrectomy. Such changes may cause impairment of renal function and reduce the patient’s quality of life [ 2 – 5 ]. Through examination of non-neoplastic renal parenchymal changes in 110 cancer-related nephrectomy specimens, Bijol et al showed that only 10% of the cases have unremarkable parenchyma and those with considerable pathological changes such as severe parenchymal scarring and more than 20% glomerulosclerosis had progressive worsening of renal function in 6-month follow-up after radical nephrectomy [ 6 ].…”