Analysis of nonneoplastic medical renal diseases in tumor nephrectomy specimens predicting future renal function

Abstract

Introduction: Nephrectomy for renal tumor leads to decline in global renal function. The pattern of pathological changes in uninvolved renal parenchyma of nephrectomy specimen is useful to predict the future renal function. Aim: The aim of the present study is to analyze the spectrum of medical renal diseases in nonneoplastic renal parenchyma of tumors nephrectomies and preexisting comorbidities to predict future renal function. Materials and Methods: A prospective study was conducted on 100 nephrectomy patients during the period from November 2015 to February 2019. Nonneoplastic renal parenchyma of nephrectomy specimens was analyzed for the presence of any pathological changes. Serum creatinine levels at preoperative and 6 months after nephrectomy were recorded. Results: Medical renal disease in uninvolved renal parenchyma detected in 52% of cases and arterionephrosclerosis (28%) followed by diabetic nephropathy (10%) was most frequently seen. Diabetes mellitus (DM) and/or hypertension (HTN) were significantly associated with increase in arteriolar hyalinosis, glomerulosclerosis, and interstitial fibrosis/tubular atrophy (P < 0.05). The median follow-up for patients attending 6 months after nephrectomy (n = 41) was 20 months with the mean increase in serum creatinine level from the preoperative period of 0.48 mg/dl (P = 0.011). The increase in serum creatinine level from the preoperative period to 6 months after nephrectomy was significant for patients with preexisting DM alone (P = 0.033), DM along with HTN together (P = 0.008), and patients with diabetic nephropathy (P = 0.0001). Three patients developed chronic kidney disease during follow-up (n = 41). Conclusions: Preexisting DM and HTN should be carefully handled in renal tumor patients and routine evaluation of the nonneoplastic renal parenchyma of nephrectomy specimens is necessary to detect the presence of subclinical renal disease for early treatment measures to reduce future morbidity.