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Sources of Funding: none

Introduction

The current evaluation of nephrectomy specimens centers on the pathological diagnosis, grade, and stage of the neoplasm._x000D_ The evaluation of the non-neoplastic renal parenchyma is often overlooked. The remnant renal parenchyma can suffer the long-term effects of comorbidities, compromising functional outcomes. These changes can be assessed by histopathological analysis of non-neoplastic tissue of the nephrectomy specimen and can be used to predict the extent of future renal function compromise. In this study, we aim to evaluate changes in the non-neoplastic renal parenchyma in patients who were submitted to radical nephrectomy, as well as demographic and clinical parameters as predictors of decrease in renal function and development of new-onset CKD after surgery._x000D_

Methods

Data were extracted from 222 patients who underwent radical nephrectomy. The MDRD formula was used. The study end point was development of CKD, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. A renal pathologist assessed three histologic features in the non-neoplastic parenchyma, namely global glomerulosclerosis (GS), arteriosclerosis (AS), and interstitial fibrosis (IF). For GS assessment, the percent of affected glomeruli was determined. AS was graded and divided into three groups, namely 1—0%-25%, 2—26%-50%, and 3—greater than 50%. IF was evaluated as absent or present. _x000D_ A nomogram was created to predict CKD following radical nephrectomy._x000D_

Results

After a mean follow-up of 49.06 months, the mean eGFR rate decrease was 26.5% after radical nephrectomy. Almost half of the patients (53.8%) developed CKD. For each 2.5% increase in GS, each point increase in Charlson comorbidity index, and each 10-year increase in patient’s age, the eGFR decreased 28%, 33%, and 39%, respectively. In a univariate analysis, age, CCI, GS, AS, IF, hypertension, and DM were associated with new-onset CKD after radical nephrectomy. After multivariate logistic regression, CCI, GS, and baseline eGFR were associated with new-onset CKD after radical nephrectomy.

Conclusions

Histopathological evaluation of non-neoplastic renal parenchyma in patients who undergo radical nephrectomy can be used to predict the development of new-onset CKD.

Funding

none