Histologic Abnormalities in Non-neoplastic Renal Parenchyma and the Risk of Chronic Kidney Disease Following Radical Nephrectomy

Brandina, Ricardo; Leite, Kátia R. M.; Gregório, Émerson Pereira; Fernandes, Karen Barros Parron; Srougi, Miguel

doi:10.1016/j.urology.2016.09.041

Cited by 8 publications

(17 citation statements)

References 15 publications

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“…2 A study in 222 patients followed for a mean of 4 years found glomerulosclerosis, arteriosclerosis, and interstitial fibrosis in adjacent non-neoplastic kidney tissue to predict eGFR decline. 5 Overall, this study expands on this prior literature with a larger sample size, longer follow-up, less distorted histology by excluding partial nephrectomy specimens, focus on the nonsurgical decline in eGFR after nephrectomy, accurate and quantitative morphologic measures of nephrosclerosis, assessment of nephron size as a predictor, and more thorough adjustment for CKD risk factors and kidney function (including proteinuria).…”

Section: Discussionmentioning

confidence: 71%

“…Prior kidney structure-outcome associations in patients undergoing nephrectomy have used small samples (49-222 patients) with short follow-up and had limited and only descriptive characterization of the structural pathology. [2][3][4][5][6][7] Adjustment for baseline kidney function has been lacking or inadequate. Many of these studies also included patients who had a partial nephrectomy.…”

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confidence: 99%

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Larger Nephron Size and Nephrosclerosis Predict Progressive CKD and Mortality after Radical Nephrectomy for Tumor and Independent of Kidney Function

Denic

Elsherbiny

Mullan

et al. 2020

JASN

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BackgroundNephron hypertrophy and nephrosclerosis may be important determinants of CKD and mortality. However, studies of outcomes associated with these microstructural features have been limited to small tissue specimens from patients selected for either good kidney health or known kidney disease.MethodsTo determine whether microstructural features are predictive of progressive CKD and mortality outcomes, we studied patients who underwent a radical nephrectomy for a tumor. Large wedge sections of renal parenchyma distal to the tumor were stained and scanned into high-resolution images; we annotated the cortex and all glomeruli to calculate glomerular volume, cortex volume per glomerulus, and percentage of globally sclerotic glomeruli. Morphometric measurements also included percentages of artery luminal stenosis and interstitial fibrosis/tubular atrophy (IF/TA) of the cortex. At follow-up visits every 6–12 months, we determined which patients experienced progressive CKD (defined as dialysis, kidney transplantation, or a 40% decline from postnephrectomy eGFR). Cox models for these outcomes were adjusted for age, sex, body mass index, hypertension, diabetes, smoking, eGFR, and proteinuria.ResultsAmong 936 patients (mean age, 64 years; postnephrectomy baseline eGFR, 48 ml/min per 1.73 m2), 117 progressive CKD events, 183 noncancer deaths, and 116 cancer deaths occurred during a median follow-up of 6.4 years. Larger glomerular volume, larger cortex per glomerulus, and higher percentage of globally sclerotic glomeruli or IF/TA predicted progressive CKD. Higher percentage IF/TA also predicted noncancer mortality. Microstructural features did not predict cancer mortality or recurrence.ConclusionsAfter a radical nephrectomy, larger nephrons and nephrosclerosis predicted progressive CKD, and IF/TA predicted noncancer mortality. Morphometric analysis of renal parenchyma can predict noncancer clinical events in patients long after their radical nephrectomy.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Larger Nephron Size and Nephrosclerosis Predict Progressive CKD and Mortality after Radical Nephrectomy for Tumor and Independent of Kidney Function

Denic

Elsherbiny

Mullan

et al. 2020

JASN

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“…In recent years, emerging data proved that certain histological changes can be identified in the peritumoral parenchyma of RCC [ 1 – 7 ]. In 2013, Garcia-Roig et al [ 4 ] conducted an observational study on 45 patients who underwent PN surgery and who had no known chronic underlying disease.…”

Section: Discussionmentioning

confidence: 99%

“…These studies suggested that lesions in the peritumoral parenchyma were indicative of subclinical kidney disease and advocated that patients with RCC could potentially benefit from intensive lifestyle modification and medical therapy with lipid-lowering medications [ 5 ]. However, more recent studies [ 8 – 10 ] have analyzed broader areas of non-neoplastic renal tissue. Azhar et al [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…A limited number of studies have focused on the comprehensive pathological analysis of non-neoplastic parenchyma in renal cell carcinoma (RCC), which includes the peritumoral parenchyma and the more distant parenchyma from the tumor. Former research [ 1 – 7 ] has only focused on peritumoral tissues, showing that various histological changes occur in the non-neoplastic parenchyma in RCC, such as chronic inflammation (CI), glomerulosclerosis (GS) or arteriosclerosis (AS). Recent reports [ 8 – 10 ] have begun to analyze the areas of renal tissues located further from the tumor, proving that the peritumoral tissue cannot represent the condition of the entire non-neoplastic parenchyma.…”

Section: Introductionmentioning

confidence: 99%

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Pathologic analysis of non-neoplastic parenchyma in renal cell carcinoma: a comprehensive observation in radical nephrectomy specimens

et al. 2017

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BackgroundThis study provides a comprehensive examination of the histological features of non-neoplastic parenchyma in renal cell carcinoma (RCC). We prospectively collected radical nephrectomy (RN) specimens, to analyze the histological changes within peritumoral and distant parenchyma.MethodsData of patients who underwent RN and had no known history of diabetes, hypertension, hyperlipidemia, or chronic kidney disease etc., were prospectively collected. Tumor pseudo-capsule (PC), and parenchyma within 2 cm from tumor margin, were pathologically assessed. The parenchyma beyond PC or tumor margin was divided into 20 subsections of 1 mm in width. Histological changes, including chronic inflammation, glomerulosclerosis, arteriosclerosis and nephrosclerosis, were given scores of 0, 1, 2 or 3 for each subsection of each specimen, according to their severity. The 20 subsections of each specimen were further divided into four groups according to the distance from the tumor edge (group 1: 0–2 mm; group 2: 2–5 mm; group 3: 5–10 mm; group 4: 10–20 mm), to better compare the peritumoral parenchyma with the distant parenchyma.ResultsIn total, 53 patients were involved in this study. All tumors were confirmed RCCs (clear cell vs. papillary vs. chromophobe were 83% vs. 5.7% vs. 11.3%, respectively), with a mean size of 5.6 cm. Histological changes were more severe in peritumoral parenchyma close to PC or tumor edge (0–5 mm), and less common within parenchyma more distant from the tumor (5–20 mm) (p < 0.001). chronic inflammation and nephrosclerosis were the most common changes especially in peritumoral parenchyma (0-2 mm). PC was present in 49 tumors (92.5%), and PC invasion occurred in 5 cases (10.2%). Mean PC thickness was 0.7 mm. PCs were more likely to be present in clear cell RCC or papillary RCC than in chromophobe RCC (100% vs. 100% vs. 33.3%, respectively; p < 0.001).ConclusionsMost RCCs have a well-developed PC, especially clear cell RCC. Histological changes mainly occur in peritumoral parenchyma, being rather uncommon in distant parenchyma. A compression band filled with severe histological changes was typically observed in renal parenchyma close to the tumor. Its preservation while performing an enucleation margin may not be entirely necessary.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3849-5) contains supplementary material, which is available to authorized users.

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

et al. 2021

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Background Nephrectomy is the management of choice for the treatment of renal tumors. Surgical pathologists primarily focus on tumor diagnosis and investigations relating to prognosis or therapy. Pathological changes in non-neoplastic tissue may, however, be relevant for further management and should be thoroughly assessed. Methods Here, we examined the non-neoplastic renal parenchyma in 206 tumor nephrectomy specimens for the presence of glomerular, tubulo-interstitial, or vascular lesions, and correlated them with clinical parameters and outcome of renal function. Results We analyzed 188 malignant and 18 benign or pseudo-tumorous lesions. The most common tumor type was clear cell renal cell carcinoma (CCRCC, n = 106) followed by papillary or urothelial carcinomas (n = 25). Renal pathology examination revealed the presence of kidney disease in 39 cases (18.9%). Glomerulonephritis was found in 15 cases (7.3%), and the most frequent was IgA nephropathy (n = 6; 2.9%). Vasculitis was found in two cases (0.9%). In 15 cases we found tubulo-interstitial nephritis, and in 9 severe diabetic or hypertensive nephropathy. Partial nephrectomy was not linked to better eGFR at follow-up. Age, vascular nephropathy, glomerular scarring and interstitial fibrosis were the leading independent negative factors influencing eGFR at time of surgery, whereas proteinuria was associated with reduced eGFR at 1 year. Conclusion Our large study population indicates a high incidence of renal diseases potentially relevant for the postoperative management of patients with renal neoplasia. Consistent and systematic reporting of non-neoplastic renal pathology in tumor nephrectomy specimens should therefore be mandatory.

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Histologic Abnormalities in Non-neoplastic Renal Parenchyma and the Risk of Chronic Kidney Disease Following Radical Nephrectomy

Cited by 8 publications

References 15 publications

Larger Nephron Size and Nephrosclerosis Predict Progressive CKD and Mortality after Radical Nephrectomy for Tumor and Independent of Kidney Function

Larger Nephron Size and Nephrosclerosis Predict Progressive CKD and Mortality after Radical Nephrectomy for Tumor and Independent of Kidney Function

Pathologic analysis of non-neoplastic parenchyma in renal cell carcinoma: a comprehensive observation in radical nephrectomy specimens

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

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