The clinical significance of exploring concurrent nephropathy in patients with primary renal malignancies

This study aimed to compare the clinicopathological features and clinical outcomes between patients with primary renal malignancies with pathologically diagnosed nephropathy (PRMN) and those with isolated primary renal malignancies (IPRMs).

We enrolled 31 patients with PRMN and 31 matched controls with IPRM between 2013 and 2023. Clinical characteristics, tumour pathological features, therapeutic interventions and prognostic outcomes were systematically analysed. Nephropathy was diagnosed by immunofluorescence, immunohistochemistry and light microscopy.

Patients in the PRMN group were younger, with a higher proportion of males and those with a smoking history. Preoperative and postoperative serum creatinine (Scr) were significantly higher in the PRMN group than in the IPRM group, while estimated glomerular filtration rate (eGFR) was significantly lower. Peritumoural renal tissues in the PRMN group showed more severe pathological changes, including global glomerulosclerosis (GS), segmental glomerulosclerosis (SS), and interstitial fibrosis and tubular atrophy (IFTA). Tumour treatment modalities did not differ significantly between groups. However, the PRMN group had a significantly higher all-cause mortality rate (19.4% vs. 0%, p = 0.007). Logistic regression showed that postoperative Scr (aOR = 1.176, 95% CI: 1.067-1.296; p = 0.001) and postoperative eGFR (aOR = 1.205, 95% CI: 1.065-1.362; p = 0.003) were significantly associated with PRMN. ROC analysis suggested that preoperative Scr (cutoff = 78.5 μmol/L) had diagnostic value for identifying PRMN. Kaplan-Meier's analysis showed that overall survival and composite endpoint survival were significantly lower in the PRMN group (p < 0.05). In exploratory Cox regression, age showed a potential association with the composite endpoint (HR = 1.138, 95% CI: 1.007-1.286, p = 0.038), though this finding requires validation.

Patients with PRMN exhibited distinct clinicopathological characteristics, factors associated with disease progression, and a higher incidence of adverse outcomes compared to those with IPRM.