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

OBJECTIVE: To assess the association of histopathological parameters in non-neoplastic renal parenchyma with the development of new-onset chronic kidney disease (CKD) after radical nephrectomy.

PATIENTS AND METHODS: Data were extracted from 222 patients who underwent radical nephrectomy. The Modification of Diet in Renal Disease 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.

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 (CCI), and each 10-year increase in patient's age, the eGFR decreased 28%, 33%, and 39%, respectively (P < .05). In a univariate analysis, age, CCI, GS, AS, IF, hypertension, and diabetes mellitus were associated with new-onset CKD after radical nephrectomy (P < .05). After multivariate logistic regression, CCI, GS, and baseline eGFR were associated with new-onset CKD after radical nephrectomy.

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