Histopathological analysis of the non – tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

Vol. 43 (4): 655-660, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0417


ORIGINAL ARTICLE

Rana Birendra 1, Nirmal Thampi John 2, Neelaveni Duhli 2, Antony Devasia 1, Nitin Kekre 1, Ramani Manojkumar 2
1 Department of Urology, Christian Medical College, Vellore; 2 Department of Pathology, Christian Medical College, Vellore

 

ABSTRACT

Introduction: Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney.

Materials and Methods: Aim of this prospective, observational study was to find histo­pathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months.

Results: 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show asso­ciation with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyali­nosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=.028).

Conclusion: Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant de­crease in renal function postoperatively.

Keywords: Nephrectomy; Arteriosclerosis; Glomerulosclerosis, Focal Segmental

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