title: Characterization of mild and severe post-radical nephrectomy renal functional deterioration utilizing histopathological evaluation of non-neoplastic nephrectomized renal parenchyma.
abstract: BACKGROUND
  We investigated factors affecting mild (MRFD) and severe renal functional deterioration (SRFD) after radical nephrectomy with a special focus on the histopathology of nephrectomized non-neoplastic renal parenchyma.
  
  
  METHODS
  MRFD was defined as a postoperative decline of percent estimated glomerular filtration rate (eGFR) lower than the value of the mean minus standard deviation (SD). SRFD was defined as a rate greater than the value of the mean plus SD. The histopathological factors of global glomerulosclerosis (GS) and arteriosclerosis in non-neoplastic renal parenchyma and multiple clinical factors were analyzed to determine whether they affected postoperative renal functional deterioration in 100 renal cell carcinoma cases. The prognoses, including non-cancer mortality, were collected from long-term follow-up data.
  
  
  RESULTS
  A higher preoperative eGFR and a higher global GS extent in non-neoplastic renal parenchyma were independently associated with MRFD and SRFD, respectively. The cardiovascular disease-specific survival rates of the SRFD group and the group with global GS extent >14 % were significantly worse than those of their counterparts.
  
  
  CONCLUSIONS
  This is the first report to identify global GS extent in nephrectomized non-neoplastic renal parenchyma as a factor affecting the development of life-threatening post-nephrectomy renal functional deterioration. Moreover, we are the first to advocate the importance of the characterization of favorable post-nephrectomy renal functional deterioration. The identification of MRFD and SRFD by histopathological evaluation of nephrectomized non-neoplastic renal parenchyma will contribute to personalized postoperative follow-up. It may improve follow-up of individual patients with SRFD by permitting collaboration with other clinical departments such as cardiology.
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan. sejimat@grape.med.tottori-u.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yumioka
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Yamaguchi
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Honda
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000150:complications / Q000473:pathology*; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011184:Postoperative Period; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology*; D015996:Survival Rate
keywords: Cardiovascular disease; Chronic kidney disease; Global glomerulosclerosis; Radical nephrectomy; Renal parenchymal histopathology