[1483] Evaluation of Nonneoplastic Renal Parenchyma in Partial Nephrectomies.

Carlos Parra-Herran, Michael Garcia-Roig, Merce Jorda, Michael Gorin, Bruce Kava, Murugesan Manoharan, Mark Soloway, Gaetano Ciancio, Monica Garcia-Buitrago. U Miami Jackson Memorial Hosp, FL

Background: Pathologic changes in nonneoplastic renal parenchyma (NNRP) are associated with progression to renal failure. Compared to total nephrectomies, evaluation of those changes in partial nephrectomies (PN) is less consistent. We postulate that pathologic changes in the NNRP of PN can be adequately assessed and may have therapeutic impact after surgery.
Design: We retrieved histologic material of patients who underwent PN in a 12-year-period. Demographic data, comorbilities, tumor features, creatinine levels and glomerular filtration rate (GFR) pre and post surgery was collected. NNRP was assessed for glomerular, tubulointerstitial and vascular changes. Peritumoral parenchyma (1mm) was not evaluated. The findings were correlated with clinical data.
Results: A total of 174 patients underwent PN. Of those, 104 were available. Ten patients were excluded due to lack of NNRP. 94 patients (57M, 37F) were studied. The patient's mean age was 58.5 years. Patient's comorbilities included Diabetes mellitus (DM, 18%), hypertension (HTN, 53%), and coronary artery disease (CAD, 12%). Resected tumors were neoplastic (conventional renal cell carcinoma 64%, papillary 17%, others 17%) and nonneoplastic (2%). The most frequent NNRP lesions included mesangial expansion (24%), atherosclerosis (22%), interstitial fibrosis (18%), arteriolosclerosis (7%) and >20% global glomerulosclerosis (6%). Presence of these combined pathologic changes was associated with HTN, DM and CAD (Table 1).

CORRELATION BETWEEN PATHOLOGIC CHANGES, COMORBILITIES AND RENAL FUNCTION (RF)

		PATHOLOGIC CHANGES
		PRESENT	ABSENT	TOTAL
HTN	YES	49	1	50
	NO	39	5	44
	TOTAL	88	6	94
DM	YES	16	1	17
	NO	71	6	77
	TOTAL	87	7	94
CAD	YES	11	0	11
	NO	74	9	83
	TOTAL	85	9	94
DECREASED RF	YES	21	1	22
	NO	51	3	54
	TOTAL	72	4	76

Renal function data was available in 76 patients. Significant change (>20% raised creatinine and decreased GFR) between pre and postoperative period was seen in 22 patients, 21 showed NNRP changes. Of 39 patients with no history of comorbilities, vascular (82%) and tubulointerstitial changes (33%) were seen. None of these patients showed glomerular changes.
Conclusions: Optimal evaluation of NNRP can be achieved in the vast majority of PN (90% in our series). Pathologic changes are found in a significant amount of cases, including those without history of comorbilities, and may be associated with risk of RF impairment. Thus, adequate pathologic assessment of NNRP should always be performed in PN, since it can alert the clinician about progression of renal disease and need for close follow up.
Category: Kidney (does not include tumors)

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 195, Monday Morning