title: Histologic Abnormalities in Non-neoplastic Renal Parenchyma and the Risk of Chronic Kidney Disease Following Radical Nephrectomy.
abstract: OBJECTIVE
  To assess the association of histopathological parameters in non-neoplastic renal parenchyma with the development of new-onset chronic kidney disease (CKD) after radical nephrectomy.
  
  
  METHODS
  Data were extracted from 222 patients who underwent radical nephrectomy. The Modification of Diet in Renal Disease formula was used. The study end point was development of CKD, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. A renal pathologist assessed three histologic features in the non-neoplastic parenchyma, namely global glomerulosclerosis (GS), arteriosclerosis (AS), and interstitial fibrosis (IF). For GS assessment, the percent of affected glomeruli was determined. AS was graded and divided into three groups, namely 1-0%-25%, 2-26%-50%, and 3-greater than 50%. IF was evaluated as absent or present.
  
  
  RESULTS
  After a mean follow-up of 49.06 months, the mean eGFR rate decrease was 26.5% after radical nephrectomy. Almost half of the patients (53.8%) developed CKD. For each 2.5% increase in GS, each point increase in Charlson comorbidity index (CCI), and each 10-year increase in patient's age, the eGFR decreased 28%, 33%, and 39%, respectively (P < .05). In a univariate analysis, age, CCI, GS, AS, IF, hypertension, and diabetes mellitus were associated with new-onset CKD after radical nephrectomy (P < .05). After multivariate logistic regression, CCI, GS, and baseline eGFR were associated with new-onset CKD after radical nephrectomy.
  
  
  CONCLUSIONS
  Histopathological evaluation of non-neoplastic renal parenchyma in patients who undergo radical nephrectomy can be used to predict the development of new-onset CKD.
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, SP, Brazil. Electronic address: rbrandina@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Brandina
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Katia Ramos
authors.initials: KR
authors.lastname: Moreira Leite
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Emerson Pereira
authors.initials: EP
authors.lastname: Gregório
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Karen Barros Parron
authors.initials: KBP
authors.lastname: Fernandes
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D000072356:Parenchymal Tissue / Q000473:pathology*; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome