Wee Jee Wan, Kang Hye Ran, Kwon Soon Hyo, Jeon Jin Seok, Han Dong Cheol, Jin So-Young, Yang Won Jae, Noh Hyunjin
Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Department of Pathology, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2016 Jul;31(4):739-49. doi: 10.3904/kjim.2015.392. Epub 2016 May 30.
BACKGROUND/AIMS: While surgical resection remains the standard of care in the treatment of upper urinary tract malignancies, nephrectomy is a risk factor for the development of chronic kidney disease (CKD). The aim of this study was to determine whether histologic evaluation of non-neoplastic kidney could enable early identification of unrecognized kidney disease and could be of prognostic value in predicting postoperative renal outcomes.
We retrospectively analyzed 51 patients with upper urinary tract malignancies who received uninephrectomy or uninephroureterectomy. A thorough pathologic evaluation of non-neoplastic kidney including special stains, immunofluorescence, and electron microscopic studies was performed. The degree of parenchymal changes was graded from 0 to 15.
Of 51 patients, only 13 showed normal kidney pathology. Fifteen patients showed glomerular abnormalities, 14 showed diabetic nephropathy, and 11 showed vascular nephropathy. There was one case each of reflux nephropathy and chronic pyelonephritis. The median histologic score was 5 points. Only 25.4% of patients had ≤ 3 points. Score more than 5 was observed in 47.1% of patients. Postoperative estimated glomerular filtration rate (eGFR) at 3 to 36 months were obtained from 90.2% of patients, and of those, 34.8% had de novo CKD. Since no one had CKD in partial nephrectomized patients, we determined risk factors for CKD in radical nephrectomized patients. Cox regression analysis revealed that postoperative AKI, preoperative eGFR, and histologic score of non-neoplastic kidney were the independent predictors for CKD.
We conclude that routine pathologic evaluation of non-neoplastic kidney provides valuable diagnostic and prognostic information.
背景/目的：虽然手术切除仍是上尿路恶性肿瘤治疗的标准方法，但肾切除术是慢性肾脏病（CKD）发生的一个危险因素。本研究的目的是确定对非肿瘤性肾脏进行组织学评估是否能够早期识别未被发现的肾脏疾病，以及在预测术后肾脏结局方面是否具有预后价值。
我们回顾性分析了51例接受单侧肾切除术或单侧肾输尿管切除术的上尿路恶性肿瘤患者。对非肿瘤性肾脏进行了全面的病理评估，包括特殊染色、免疫荧光和电子显微镜检查。实质改变程度从0到15进行分级。
51例患者中，只有13例肾脏病理正常。15例患者出现肾小球异常，14例患者出现糖尿病肾病，11例患者出现血管性肾病。反流性肾病和慢性肾盂肾炎各有1例。组织学评分中位数为5分。只有25.4%的患者评分为≤3分。47.1%的患者评分超过5分。90.2%的患者获得了术后3至36个月的估计肾小球滤过率（eGFR），其中34.8%的患者新发CKD。由于部分肾切除患者中无人患有CKD，我们确定了根治性肾切除患者中CKD的危险因素。Cox回归分析显示，术后急性肾损伤、术前eGFR和非肿瘤性肾脏的组织学评分是CKD的独立预测因素。
我们得出结论，对非肿瘤性肾脏进行常规病理评估可提供有价值的诊断和预后信息。
