Department of Surgery (Section of Urology), University of Chicago Medical Center, Chicago, Illinois 60637, USA.
J Urol. 2010 Nov;184(5):1872-6. doi: 10.1016/j.juro.2010.06.145. Epub 2010 Sep 17.
Radical nephrectomy is inevitably associated with a variable renal function decrease. We assessed the association of histopathological parameters in nonneoplastic renal parenchyma with the renal function decrease after radical nephrectomy.
We evaluated 32 male and 17 female patients with a mean age of 55.9 years who underwent laparoscopic radical nephrectomy. Using the Cockcroft-Gault formula we calculated the estimated glomerular filtration rate preoperatively and at last followup at a mean of 19.7 months. The study end point was the percent change in the estimated glomerular filtration rate from baseline, defined as (absolute change/baseline) × 100. Three histological features in the nonneoplastic parenchyma were assessed by a renal pathologist, including global glomerulosclerosis, arteriosclerosis and interstitial fibrosis/tubular atrophy. For glomerulosclerosis assessment the percent of affected glomeruli was determined. Arteriosclerosis or the extent of arterial luminal occlusion was graded into 4 groups, including 1-0% to 5%, 2-6% to 25%, 3-26% to 50% and 4-greater than 50%. However, due to small patient numbers groups 1 and 2, and 3 and 4 were condensed, and AS was statistically evaluated as 0% to 25% or greater than 25%. Interstitial fibrosis/tubular atrophy was evaluated as absent/present.
The mean estimated glomerular filtration rate decreased 31% from 122 to 85 ml/minute/1.73 m(2) after surgery (p < 0.0001). The percent change in the estimated glomerular filtration rate was associated with glomerulosclerosis extent (p = 0.034). For each 10% increase in glomerulosclerosis the estimated glomerular filtration rate decreased by 9% from baseline. The extent of arteriosclerosis or the presence of interstitial fibrosis/tubular atrophy did not correlate with the estimated glomerular filtration rate decrease.
Glomerulosclerosis severity in nonneoplastic parenchyma can predict the rate of renal function decrease after radical nephrectomy. This histopathological parameter should be assessed in all tumor nephrectomy specimens, given that preserving renal function is important for quality of life and clinical outcome in patients with renal cancer.
根治性肾切除术不可避免地会导致肾功能的不同程度下降。我们评估了非肿瘤性肾实质中的组织病理学参数与根治性肾切除术后肾功能下降之间的关系。
我们评估了 32 名男性和 17 名女性患者，平均年龄为 55.9 岁，均接受了腹腔镜根治性肾切除术。使用 Cockcroft-Gault 公式，我们在平均 19.7 个月的时间里计算了术前和最后一次随访时的估算肾小球滤过率。研究终点是从基线开始的估算肾小球滤过率的变化百分比，定义为（绝对变化/基线）×100。一名肾脏病理学家评估了非肿瘤性实质中的 3 种组织学特征，包括全球肾小球硬化、动脉硬化和间质纤维化/肾小管萎缩。肾小球硬化评估的是受影响肾小球的百分比。动脉硬化或动脉管腔闭塞程度分为 4 组，包括 1-0%至 5%、2-6%至 25%、3-26%至 50%和 4-大于 50%。然而，由于患者人数较少，将组 1 和 2、组 3 和 4 合并，并且统计学上评估 AS 为 0%至 25%或大于 25%。间质纤维化/肾小管萎缩评估为无/有。
术后估算肾小球滤过率从 122 降至 85ml/min/1.73m2，平均下降 31%（p<0.0001）。估算肾小球滤过率的变化百分比与肾小球硬化程度相关（p=0.034）。肾小球硬化每增加 10%，估算肾小球滤过率就会从基线下降 9%。动脉硬化的程度或间质纤维化/肾小管萎缩的存在与估算肾小球滤过率的下降无关。
非肿瘤性肾实质中的肾小球硬化程度可以预测根治性肾切除术后肾功能下降的速度。鉴于保留肾功能对肾癌患者的生活质量和临床结局至关重要，因此应在所有肿瘤肾切除标本中评估这一组织病理学参数。
