Histopathological Predictors of Renal Function Decrease After Laparoscopic Radical Nephrectomy

Gautam, Gagan; Lifshitz, David A.; Shikanov, Sergey; Moore, Josiah J.; Eggener, Scott E.; Shalhav, Arieh L.; Chang, Anthony

doi:10.1016/j.juro.2010.06.145

Cited by 24 publications

(26 citation statements)

References 15 publications

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“…1 Recent reports have highlighted the utility and value of diagnosing nonneoplastic renal disease in the tumor-free portion of the nephrectomy or partial nephrectomy specimen. [2][3][4] Studies of radical nephrectomy with long-term follow-up have demonstrated significant decline in renal function in 13% to 36% of patients. 1,5 Clinical parameters associated with postnephrectomy renal insufficiency include female sex, hypertension, diabetes, and preoperative proteinuria in univariate analysis, and preoperative serum creatinine level, hypertension, and preoperative proteinuria in multivariate analysis.…”

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confidence: 99%

“…Even though one had limited follow-up (6 months) in a small group of patients (39), the authors showed a statistically significant increase in serum creatinine levels of 11 patients with vascular disease and 10 with diabetic nephropathy compared with the 14 without such change. 4 A second study by Gautam et al 2 reported that global glomerulosclerosis (GS) significantly correlated with postoperative renal function decline in 49 patients who underwent radical nephrectomy and were followed for 3 to 60.8 months.…”

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confidence: 99%

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Nonneoplastic Renal Cortical Scarring at Tumor Nephrectomy Predicts Decline in Kidney Function

Salvatore

Eugene

Rosoff

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Evaluating nontumor portions of tumor nephrectomies is useful to diagnose nonneoplastic renal disease. Objective.—To determine the medical renal disease frequency and to assess the prognostic significance of the various renal pathologic variables with long-term follow-up in tumor nephrectomy patients. Design.—We reviewed nonneoplastic kidney sections of 456 consecutive cases from 1998 to 2008. Seventy-five cases were excluded (19 tumor compression, 25 no nonneoplastic tissue, 22 embolized kidneys, 9 end stage). Special staining, immunofluorescence, and/or electron microscopy was performed where appropriate. Vascular sclerosis was scored from mild to severe; interstitial fibrosis/tubular atrophy and global glomerulosclerosis (GS) were expressed as percentages. Follow-up, minimum 12 months, was evaluated in 156 cases. All renal pathologic variables were compared with regard to change in creatinine level from preoperative assessment to follow-up. Results.—Of 381 cases, 57 had additional medical renal disease (15%), most frequently diabetic nephropathy (28) and hypertensive nephropathy (11). Postoperative creatinine levels increased significantly in patients with severe arteriosclerosis or arteriolosclerosis, >5% GS, and >10% interstitial fibrosis/tubular atrophy. Seventy-four percent of cases with additional nonneoplastic diagnoses showed severe arteriolosclerosis. Higher corresponding GS was seen in the more affected vascular cases: mean, 5.56% GS for mild versus 23% GS for severe. Three patients progressed to renal failure 1 to 4 years after nephrectomy, 2 with hypertensive nephrosclerosis and 1 with diabetic nephropathy. Conclusions.—Medical renal disease was identified in 15% of tumor nephrectomy specimens. The degrees of vascular sclerosis, GS, and interstitial fibrosis/tubular atrophy are predictive of elevated creatinine levels in postnephrectomy patients. Prognostic implications of the nontumor pathology are important in nephrectomized patients.

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confidence: 99%

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confidence: 99%

Nonneoplastic Renal Cortical Scarring at Tumor Nephrectomy Predicts Decline in Kidney Function

Salvatore

Eugene

Rosoff

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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“…To focus on the evaluation of erectile function, the severity of ED was graded as no (26-30), mild (22)(23)(24)(25), mild to moderate (17)(18)(19)(20)(21), moderate (11)(12)(13)(14)(15)(16) or severe (6-10) using the IIEF-erectile function domain data according to a previous study. 11 Five (7.7%), ten (15.4%), eleven (16.9%), nine (13.8%) and thirty (46.2%) patients were categorized as no, mild, mild to moderate, moderate and severe ED, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…However, a few studies have demonstrated the utility of global GS in the histopathological evaluation of nephrectomized normal kidney parenchyma as a predictive marker for progression of renal functional impairment after RN. 19,20 Our study is the first attempt to evaluate whether global GS is a useful biomarker for the prediction of ED. Because low levels of global GS extent and post-RN percent eGFR decrease were associated with no/mild ED in the univariate analysis, normal renal function preservation may be a minimum requirement for normal erectile function.…”

Section: Discussionmentioning

confidence: 99%

Initial evidence demonstrating the association between the vascular status in surgically resected renal parenchymal pathology and sexual function

et al. 2014

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Our goal is to evaluate the association between histopathology of glomerulosclerosis (GS) and atherosclerosis (AS) in the nephrectomized normal parenchyma together with patients' background, and erectile dysfunction (ED) of patients treated with radical nephrectomy (RN) for renal cell carcinoma (RCC). ED was assessed with the International Index of Erectile Function in 65 patients who were less than age 70 years at the time of questionnaire. Glomeruli status was assessed by the extent of global GS. AS was graded based on lumen occlusion and frequency of involvement. Patients' backgrounds included any comorbidities, post-RN renal insufficiency, tumor pathology, demographics and social status. The presence of diabetes mellitus and lack of a spouse were independent predictors for severe ED, whereas G0/1 AS was an independent predictor for mild/no ED. The extent of global GS was significantly lower in patients with mild/no ED than in other patients. Our study represents the first report identifying healthy arterial status in the renal parenchyma as a significant indicator of favorable erectile function and that the evaluation of AS severity is not a superior indicator of severe ED in the presence of comorbidities or social status among patients treated with RN.

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“…Notably, the presence and extent of glomerolosclerosis in normal parenchyma has been shown to be commensurate with deterioration in postoperative renal function, although this trend was not noted for features such as arteriosclerosis or interstitial fibrosis/ tubular atrophy. (Gautam et al, 2010;McCann et al, 2009) …”

Section: Preoperative Risk Stratification Schematamentioning

confidence: 99%

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

Badalato¹,

Kates²,

Sadeghi³

et al. 2012

Diseases of Renal Parenchyma

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Histopathological Predictors of Renal Function Decrease After Laparoscopic Radical Nephrectomy

Cited by 24 publications

References 15 publications

Nonneoplastic Renal Cortical Scarring at Tumor Nephrectomy Predicts Decline in Kidney Function

Nonneoplastic Renal Cortical Scarring at Tumor Nephrectomy Predicts Decline in Kidney Function

Initial evidence demonstrating the association between the vascular status in surgically resected renal parenchymal pathology and sexual function

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

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