Clinical and histologic predictors of renal function decline after laparoscopic partial nephrectomy

Area of Science:

• Nephrology
• Urologic Oncology
• Surgical Pathology

Background:

• Clinical and surgical factors are known predictors of renal function decline after laparoscopic partial nephrectomy (LPN).
• Histopathologic features in nonneoplastic tissue of the surgical specimen have not been extensively studied as predictors.
• This study aimed to identify novel histopathologic predictors of renal function after LPN.

Purpose of the Study:

• To investigate the significance of histologic findings in nonneoplastic parenchyma as predictors of renal function after LPN.
• To correlate perioperative and histopathologic parameters with changes in estimated glomerular filtration rate (eGFR).
• To identify factors associated with short-term (postoperative day 1) and long-term renal function decline.

Main Methods:

• Retrospective analysis of data from 150 patients who underwent LPN.
• Evaluation and grading of three histopathologic features in nonneoplastic parenchyma: glomerulosclerosis, arteriosclerosis (AS), and interstitial fibrosis/tubular atrophy.
• Correlation of these features and clinical parameters with eGFR changes at postoperative day 1 (POD1) and last follow-up (median 15 months).

Main Results:

• Median eGFR decline was -17% at POD1 and -10% at last follow-up.
• Independent predictors of POD1 eGFR decline included artery and vein clamping, male sex, and larger tumor size.
• Long-term renal function loss was associated with POD1 eGFR decline and the percentage of arteriosclerosis (AS).

Conclusions:

• Laparoscopic partial nephrectomy (LPN) generally results in favorable renal function outcomes.
• Histopathologic findings in nonneoplastic tissue, in addition to clinical parameters, can predict renal function impairment after LPN.
• Identifying these predictors can help manage patients at higher risk of kidney function decline.