title: Histopathological analysis of the non - tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?
abstract: BACKGROUND
  Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney.
  
  
  METHODS
  Aim of this prospective, observational study was to find histopathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months.
  
  
  RESULTS
  73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show association with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyalinosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=0.028).
  
  
  CONCLUSIONS
  Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant decrease in renal function postoperatively.
authors.affiliation: Department of Urology, Christian Medical College, Vellore.
authors.forename: Rana
authors.initials: R
authors.lastname: Birendra
authors.affiliation: Department of Pathology, Christian Medical College, Vellore.
authors.forename: Nirmal Thampi
authors.initials: NT
authors.lastname: John
authors.affiliation: Department of Pathology, Christian Medical College, Vellore.
authors.forename: Neelaveni
authors.initials: N
authors.lastname: Duhli
authors.affiliation: Department of Urology, Christian Medical College, Vellore.
authors.forename: Antony
authors.initials: A
authors.lastname: Devasia
authors.affiliation: Department of Urology, Christian Medical College, Vellore.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kekre
authors.affiliation: Department of Pathology, Christian Medical College, Vellore.
authors.forename: Ramani
authors.initials: R
authors.lastname: Manojkumar
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D000072356:Parenchymal Tissue / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Arteriosclerosis; Glomerulosclerosis, Focal Segmental; Nephrectomy 