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

Abstract

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.

The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma

“…Some of them have an underlying chronic disease, which will cause worsening kidney function over time [ 5 ]. In addition, pathology examination of radical nephrectomy always shows some kidney disease in the “no-tumor part” [ 6 ], which may be associated with CKD after RN [ 7 ]. Therefore, the probability of CKD after radical nephrectomy is often higher than expected.…”

The histomorphology of the senescent kidney – the clinical relevance of specimen and biopsy findings in the elderly native kidneys

“…Pathologic evaluation not only allows the discovery of renal diseases in nonneoplastic renal parenchyma or grading the extent of chronic diseases but also provides prognostic information for the follow-up of the urology and nephrology patients. In our single centre experience at the Medical University of Vienna, the thorough inspection of nonneoplastic parenchyma in tumour nephrectomy specimens recently identified a nonnegligible frequency of diseases frequently encountered in an older patient population and potentially responsible for an accelerated loss of nephrons, if not detected or treated [1]. Glomerular scarring, chronic vasculopathy, interstitial fibrosis and tubular atrophy are the hallmarks of chronic kidney diseases, leading to nephrosclerosis, and represent the bread and butter of each renal pathologist.…”