Presented by: Jennifer L Nguyen BS
Department of Urology, Hackensack University Medical Center

Introduction

American Urological Association (AUA) guidelines for the management of renal masses include the pathologic evaluation of adjacent renal parenchyma following partial (PN) or radical nephrectomy (RN) for signs of intrinsic renal disease, particularly for patients with CKD or risk factors for developing CKD. We aim to evaluate the frequency and prognostic utility of this tool at a tertiary academic center. 

Materials

We utilized a prospective, IRB-approved single-center database involving 862 patients who underwent PN or RN for a renal mass between 2017 and 2021 with GFR obtained at no fewer than 6-month follow-up. Adjacent pathological findings were classified according to the College of American Pathology Cancer Protocol guidelines. Continuous data were analyzed using a t-test. Categorical data were analyzed using Chi-Squared and Fisher’s Exact Tests.

Results

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Out of 394 patients who met inclusion criteria and underwent pathological evaluation of adjacent renal parenchyma, 287 (73%) patients underwent PN, and 107 (27%) underwent RN. There was a significant association between mean change in eGFR between radical and partial nephrectomies for vascular disease in adjacent kidney pathology (p=0.042). Finding of vascular adjacent pathology and PN had a lower change in GFR compared to RN (-5.69 vs. -20.85). Out of those that were omitted from evaluation for adjacent kidney pathology, 8.1% were from benign pathology.

Conclusion

Despite being an AUA guideline, pathological evaluation of non-neoplastic adjacent renal parenchyma is perhaps underutilized, especially for those that had benign renal disease on histopathology. The pathology synoptic report should include a template for evaluating adjacent renal parenchyma in those that have either benign or malignant renal disease. This may be important for CKD management after nephrectomy. These findings need to be corroborated through larger, multi-center analyses.

Funding

No funding was received for this work.

Co-Authors

Fahad Sheckley, MD
Department of Urology, Hackensack University Medical Center

Teona Iarajuli, MD
Department of Urology, Hackensack University Medical Center

Tanner Corse, MD
Department of Urology, Hackensack University Medical Center

Ruth Sanchez De La Rosa,
Department of Urology, Hackensack University Medical Center

Sharon Seidman,
Department of Urology, Hackensack University Medical Center

Suzannah Sorin,
Department of Urology, Hackensack University Medical Center

Katherine Kim,
Hackensack Meridian School of Medicine

Jacquelyn Roth,
Department of Urology, Hackensack University Medical Center

Martin Malik,
Hackensack Meridian School of Medicine

Simon Gelman,
Office of Research Administration, Hackensack University Medical Center

Wenlei He, MD
Department of Pathology, Hackensack University Medical Center

Gregory Lovallo, MD
Department of Urology, Hackensack University Medical Center

Ravi Munver, MD
Department of Urology, Hackensack University Medical Center

Mutahar Ahmed, MD
Department of Urology, Hackensack University Medical Center

Michael Stifelman, MD
Department of Urology, Hackensack University Medical Center