Bijol Vanesa, Mendez Gonzalo P, Hurwitz Shelley, Rennke Helmut G, Nosé Vânia
Department of Pathology and Laboratory Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Am J Surg Pathol. 2006 May;30(5):575-84. doi: 10.1097/01.pas.0000194296.74097.87.
Pathologic changes in nonneoplastic renal parenchyma of nephrectomy specimens for renal tumors and the significance of these changes with regard to the outcome of contralateral kidney function have not been studied previously. We examined the nonneoplastic renal parenchymal changes in 110 consecutive tumor nephrectomy specimens, and we correlated our findings with patients' clinical information. The material was examined for the presence of any glomerular, tubulointerstitial, or vascular pathology. In our analysis, only about 10% of cases had unremarkable renal parenchyma and vasculature. A further 28% of cases had unremarkable parenchyma, but some degree of vascular sclerosis was noted. The remaining cases (>60%) had evident pathologic abnormalities, most commonly related to vascular disease or diabetes mellitus. Regardless of the type of renal cancer they have, the majority of our cases can be placed in one of three principal groups: 1) unremarkable kidney parenchyma, with or without vascular sclerosis (38%); 2) parenchymal scarring and marked vascular changes, including cases of atheroembolic disease, and chronic thrombotic microangiopathy (28%); and 3) changes related to diabetes mellitus, such as glomerular hypertrophy, mesangial expansion, and diffuse glomerulosclerosis (24%). Follow-up data on serum creatinine 6 months postoperatively were available in a third of our patients. Patients with severe histopathologic findings (parenchymal scarring with >20% global glomerulosclerosis and advanced diffuse diabetic glomerulosclerosis) showed a significant change in serum creatinine from the preoperative period to 6 months after radical nephrectomy (P=0.001), indicative of progressive worsening of renal function; this change is significantly greater than that seen in patients with unremarkable renal parenchyma (P=0.01). We conclude that adequate examination of nonneoplastic renal parenchyma is an important tool in recognizing patients at risk for progressive renal disease after nephrectomy and could be an essential step in providing early preventive and treatment measures and better medical care of patients undergoing nephrectomy for neoplastic processes.
肾肿瘤肾切除标本中非肿瘤性肾实质的病理变化以及这些变化对侧肾功能转归的意义此前尚未得到研究。我们检查了110例连续的肿瘤肾切除标本中的非肿瘤性肾实质变化，并将我们的发现与患者的临床信息相关联。对材料进行检查以确定是否存在任何肾小球、肾小管间质或血管病变。在我们的分析中，只有约10%的病例肾实质和血管正常。另外28%的病例肾实质正常，但有一定程度的血管硬化。其余病例（>60%）有明显的病理异常，最常见的与血管疾病或糖尿病有关。无论患有何种类型的肾癌，我们的大多数病例可分为三个主要组之一：1）肾实质正常，有或无血管硬化（38%）；2）实质瘢痕形成和明显的血管变化，包括动脉粥样硬化栓塞性疾病和慢性血栓性微血管病病例（28%）；3）与糖尿病相关的变化，如肾小球肥大、系膜扩张和弥漫性肾小球硬化（24%）。三分之一的患者有术后6个月血清肌酐的随访数据。具有严重组织病理学表现（实质瘢痕形成伴>20%的全球肾小球硬化和晚期弥漫性糖尿病肾小球硬化）的患者从术前到根治性肾切除术后6个月血清肌酐有显著变化（P=0.001），表明肾功能逐渐恶化；这种变化明显大于肾实质正常的患者（P=0.01）。我们得出结论，对非肿瘤性肾实质进行充分检查是识别肾切除术后有进行性肾病风险患者的重要工具，并且可能是为接受肿瘤手术的肾切除患者提供早期预防和治疗措施以及更好医疗护理的关键步骤。
