Long-Term Follow-up after Partial Removal of a Solitary Kidney

Novick, Andrew C.; Gephardt, Gordon N.; Guz, Brian; Steinmuller, Donald; Tubbs, Raymond R.

doi:10.1056/nejm199110103251502

Cited by 277 publications

(90 citation statements)

References 22 publications

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“…The tumors were renal cell carcinoma, clear cell type (254), papillary type (62), or chromophobe type (29); oncocytoma (30); urothelial cell carcinoma (33); angiomyolipoma (14); and miscellaneous (27). In toto, 117 (30.7%) had minimal pathologic change as defined by less than 5% GS, less than 10% IF/TA, and mild or no significant vascular sclerosis (interlobular, small arteries, arterioles including hilar arterioles).…”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

“…[12][13][14] Hyperfiltration effects are further complicated by preexisting vascular, diabetic, or hypertension-associated renal parenchymal changes, which independently contribute to progressive impairment of renal function.…”

Section: Commentmentioning

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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show abstract

“…[5][6][7] In accordance with this hypothesis, individuals who have undergone nephrectomy have been shown to develop high BP and proteinuria decades after the nephrectomy, 8 -11 as in the case of older recipients with a higher body mass index 12 ; however, renal insufficiency only appears in the case of a 75% reduction in kidney mass and after at least 10 years of follow-up. 9 Kidney transplantation has been proposed as an accelerated model of nephron reduction resulting from the accumulation of several unfavorable factors. For example, repeated injuries, from initial brain death of the donor 13 to ischemia-reperfusion injury, 14 negatively affect the transplant.…”

mentioning

confidence: 99%

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral¹,

Foucher²,

Karam³

et al. 2010

Journal of the American Society of Nephrology

117

102

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Long-term function of kidney allografts depends on multiple variables, one of which may be the compatibility in size between the graft and the recipient. Here, we assessed the long-term consequences of the ratio of the weight of the kidney to the weight of the recipient (KwRw ratio) in a multicenter cohort of 1189 patients who received a transplant between 1995 and 2006. The graft filtration rate increased by a mean of 5.74 ml/min between the third and sixth posttransplantation months among patients with a low KwRw ratio (Ͻ2.3 g/kg; P Ͻ 0.0001). In this low KwRw ratio group, the graft filtration rate remained stable between 6 months and 7 years but then decreased at a mean rate of 3.17 ml/min per yr (P Ͻ 0.0001). In addition, low KwRw ratios conferred greater risk for proteinuria, more antihypertensive drugs, and segmental or global glomerulosclerosis. Moreover, a KwRw ratio Ͻ2.3 g/kg associated with a 55% increased risk for transplant failure by 2 years of follow-up. In conclusion, incompatibility between graft and recipient weight is an independent predictor of long-term graft survival, suggesting that avoiding kidney and recipient weight incompatibility may improve late clinical outcome after kidney transplantation.

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“…Furthermore, they show that the occurrence of glomerulosclerosis can be prevented by the use of ACE inhibitors or by a low protein diet (reviewed in 9). In humans, sequential studies of few patients with an important reduction of their renal mass have also shown that a decrease in nephron number can also be responsible for the development of glomerulosclerosis (10,11).…”

Section: Glomerulosclerosismentioning

confidence: 99%

Anemia Management and the Delay of Chronic Renal Failure Progression

Rossert

Fouqueray

Boffa

2003

Journal of the American Society of Nephrology

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ABSTRACT. Interstitial fibrosis plays a key role in the progression of chronic kidney diseases. Analysis of the biologic effects of erythropoietin and of the pathophysiology of interstitial fibrosis suggest that treatment with epoetin may slow the progression of chronic kidney disease, both by decreasing interstitial fibrosis and by protecting against its consequences. The results of two small prospective studies and of a retrospective one also suggest that treatment with epoetin may have such protective effects. E-mail: jerome.rossert@tnn.ap-hop-paris.fr

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Long-Term Follow-up after Partial Removal of a Solitary Kidney

Abstract: Long-term renal function remains stable in most patients with a reduction in renal mass of more than 50 percent. These patients are, however, at increased risk for proteinuria, glomerulopathy, and progressive renal failure.

Cited by 277 publications

References 22 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

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Anemia Management and the Delay of Chronic Renal Failure Progression

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