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).