Clinical Value Of Pathological Evaluation Of Non-neoplastic Renal Parenchyma In Patients With Kidney Tumor

Objective:To explore the incidence and risk factors of chronic kidney disease(CKD)that were not identified or without pathological diagnosis before operation in patients with kidney tumor,and to provide evidences for early detection and early treatment of postoperative renal insufficiency.Methods: 51 specimens of non-neoplastic renal parenchyma of patients diagnosed with kidney tumor and need to have surgery were collected from the Urinary Surgery of Fujian Provincial Hospital from July 2016 to February 2017.The non-neoplastic renal parenchyma specimens were taken from a relatively distant location of the renal tumor margins(>3cm)in radical nephretomy(RN)or radical nephroureterectomy(RNU),and taken from the farthest distance of the tumor margins(about 0.5cm)in partial nephrectomy(PN).All specimens were routinely examined by HE,PAS,PASM and Masson staining and histopathological examination by light microscopy,some specimens were further examined by electron microscopy.Results: A total of 50 specimens were enrolled in this study,after excluded 1 case affected by tumor compression.The average age of these 50 patients was 55.7 ±12.3 years,the ratio of male to female was 3:2,the total glomerular filtration rate(GFRbody surface)that calculated by renal dynamic imaging and Standardized by body surface area was 88.9(78.7-107.9)ml·min-1·(1.73 m2)-1.The average GFRbody surface of the operated kidney was 47.6±13.2 ml·min-1·(1.73 m2)-1.There were only 3 cases with abnormal GFRbody surface(<60 ml·min-1·(1.73 m2)-1)in the 50 patients,the rest were within the normal range.We found that at least 96% of patients with kidney tumors had one or more different degrees of pathological changes for example,glomerular sclerosis,renal vascular sclerosis,interstitial fibrosis and tubular atrophy,etc.Furthermore,the most significant finding was that there were 17 patients(34%)can make a definite pathological diagnosis,one of the most common pathological types was hypertensive nephropathy(20%),the remaining was Ig A nephropathy(14%),in addition,1 case was diagnosed as Ig A nephropathy complicated with hypertensive nephropathy.The results of single factor analysis showed that the number of patients with the history of hypertension(P=0.006),diabetes mellitus(P=0.040)and smoking(P=0.037)and male(P=0.021)in CKD group were significantly higher than the patients in non CKD group;The age of patients in CKD group(P=0.001)was significantly higher than patients in non CKD group;The total GFRbody surface(P=0.048)and operation renal GFRbody surface(P=0.034)in CKD group were significantly lower than those in non CKD group,while,there were no significant difference between the two groups in BMI,tumor size,cardiovascular disease,hematuria and proteinuria.Multivariate unconditional Logistic regression analysis showed that the age(P=0.044)and male(P=0.044)were independent risk factors for chronic kidney disease,but hypertension(P=0.062)was also included in the regression equation.Conclusion: 1.Our study confirmed that 34% of the renal tumor patients with normal renal function before surgery had a CKD that had not been identified but could make a definite pathological diagnosis,is hypertensive nephropathy(20%)and Ig A nephropathy(14%),and the proportion of different degree of pathological changes of renal parenchyma was greater.2.Multivariate Logistic regression analysis showed that the ageing and male were independent risk factors for chronic kidney disease,but hypertension was also included in the regression equation,and it's OR value is relatively high.3.So,a large proportion of renal dysfunction after surgery can be attributed to the pathological changes of renal parenchyma in patients with kidney tumor and have operative indication of nephron-sparing surgery,urological surgeon should be fully aware of the adverse effects of potential CKD to postoperative renal function,especially in older men with hypertension.4.Recommending routine pathological examination of the non-neoplastic renal parenchyma in the resected specimens of patients with kidney tumors in clinical practice,which can understand whether it has CKD and chronic pathological changes or not.5.If the technical condition permit,patients with kidney tumor and have operative indication of nephron-sparing surgery should first choose nephron-sparing surgery,especially in patients with high risk factors,such as ageing,hypertension and diabetes,etc.6.The impacts of patient with kidney tumor has CKD and other chronic pathological changes before surgery on the recovery and changes of renal function after surgery awaits further study.