[1488] Arteriolar Sclerosis in Tumor Nephrectomy Specimens Is Prognostically Significant.

Steven P Salvatore, Sruthi N Reddy, Eugene K Cha, James S Rosoff, Surya V Seshan. Weill Cornell Medical College, New York

Background: Recent studies have shown that evaluating non-tumor portions of tumor nephrectomy specimens is useful in diagnosing non-neoplastic renal disease. The purpose of this study is to determine the frequency of medical renal disease and to assess the prognostic significance of the degree of vascular sclerosis in the long term follow-up of tumor nephrectomy patients.
Design: We reviewed non-neoplastic kidney H&E stained slides of 232 cases from 1998 to 2005. Sixteen cases were excluded from the study (6 tumor compression, 5 no uninvolved kidney, 5 embolization/ infarction). PAS staining, immunofluorescence, and/or electron microscopy was performed where appropriate. Vascular sclerosis was scored from 0-3, mild, moderate and severe. Follow-up of at least 1 year was evaluated in 101 cases. The degree of vascular sclerosis was compared to the change in the creatinine level, pre-surgery to follow-up (Table 1).
Results: Of the 216 cases reviewed, 47 had new pathologic diagnoses (21%): diabetic nephropathy 21, hypertensive nephropathy 11, focal segmental glomerulosclerosis 6, collapsing glomerulopathy 2, acute pyelonephritis, thrombotic microangiopathy, atheroembolic disease, granulomatous interstitial nephritis, reflux nephropathy, proliferative glomerulonephritis, and membranous glomerulonephritis 1 each. Eighty percent (80%) of the cases with additional non-neoplastic diagnoses and follow-up showed severe arteriolar sclerosis. Global glomerulosclerosis (GS) was higher in cases with more severe vascular sclerosis, mean 4.5% GS (mild) versus 17% GS (severe). Three patients, all diabetic nephropathy, progressed to end stage renal disease from 1 to 4 years after nephrectomy.

Arterioles	N	mean Cr difference (mg/dL)	p value	mean f/u (yrs)
mild	42	0.3	0.006*	5.6
moderate	33	0.4	0.02*	5.1
severe	26	0.8	n/a	4.9
Arteries
mild	47	0.3	0.09	5.9
moderate	33	0.5	0.23	4.2
severe	21	0.7	n/a	4.4

*statistically significant


Conclusions: Non-neoplastic renal pathology can be evaluated in the majority of tumor nephrectomy specimens with 21% having additional diagnoses. The degree of arteriolar sclerosis but not arteriosclerosis is predictive of significantly higher creatinine levels and subsequent decline in renal function at follow-up in post-nephrectomy patients. The prognostic implications of the non-tumor pathology are therefore important in patients with reduced renal mass.
Category: Kidney (does not include tumors)

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 261, Wednesday Afternoon