Kidney Week

Abstract: PO2250

Evaluation of Preexisting Renal Disease in Nephrectomies

Session Information

• Pathology and Lab Medicine: Clinical
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1602 Pathology and Lab Medicine: Clinical

Authors

• Salcedo Betancourt, Juan David, University of Miami School of Medicine, Miami, Florida, United States

Juan David Salcedo Betancourt,

• Iakymenko, Oleksii, University of Miami School of Medicine, Miami, Florida, United States

Oleksii Iakymenko,

• Goodrich, Kenny Alexander, University of Miami School of Medicine, Miami, Florida, United States

Kenny Alexander Goodrich,

• Rozas, Jhoan B., University of Miami School of Medicine, Miami, Florida, United States

Jhoan B. Rozas,

• Philips, Ragi, University of Miami School of Medicine, Miami, Florida, United States

Ragi Philips,

• Fornoni, Alessia, University of Miami School of Medicine, Miami, Florida, United States

Alessia Fornoni,

• Contreras, Gabriel, University of Miami School of Medicine, Miami, Florida, United States

Gabriel Contreras,

• Parekh, Dipen, University of Miami School of Medicine, Miami, Florida, United States

Dipen Parekh,

• Barisoni, Laura, Duke University School of Medicine, Durham, North Carolina, United States

Laura Barisoni,

• Florindez, Jorge A., University of Miami School of Medicine, Miami, Florida, United States

Jorge A. Florindez,

• Thomas, David B., IYM Health Financial Services, PLLC, Charlotte, North Carolina, United States

David B. Thomas,

• Munoz Mendoza, Jair, University of Miami School of Medicine, Miami, Florida, United States

Jair Munoz Mendoza,

Background

Evaluation of non-neoplastic renal parenchyma in nephrectomies is part of the College of American Pathologists (CAP) Cancer Protocols. We aimed to determine the prevalence of pre-existing renal diseases in all patients who underwent nephrectomy for any cause in our center.

Methods

The surgical pathology protocol for nephrectomies was modified with a) additional sampling of non-tumoral renal parenchyma, b) Hematoxylin and eosin, Periodic acid-Schiff, trichrome and silver stains, and c) addition of the expanded checklist for reporting nephrectomy from the Renal Pathology Society recommendations. All samples were reviewed by 2 trained nephropathologist (NP). A total of 813 nephrectomies (49% partial and 51% radical) performed between 2013 and 2017 were evaluated and included in the study. Reasons for nephrectomies were malignancy in 645 (79%) of patients, of which 528 (82%) had renal cell carcinoma, 100 (16%) urothelial carcinoma, and 168 (21%) benign lesions (42 oncocytomas, 34 pyelonephritis, 13 trauma, and 8 nephrolithiasis). Clinical, demographic, and pathological data were collected by chart review.

Results

The mean age was 60 ± 14 years. 62% were male and 44% Hispanics, 59% had hypertension, 22% had diabetes mellitus, and 24% had a history of smoking. Baseline eGFR was 73 ± 27 ml/min/1.73m² and 31% had an eGFR < 60 ml/min/1.73m². Only 41 patients (5%) had a documented pre-operative consult to nephrology. 296 (36%) patients had at least one renal disease diagnosis and only 62 (8%) had a single diagnosis. 374 pathological diagnoses were reported including focal segmental glomerulosclerosis (FSGS) (157), mostly NOS variant (88%), diabetic glomerulosclerosis (57), interstitial nephritis (66), arterionephrosclerosis (39), pyelonephritis (36), acute tubular injury (10), chronic sclerosing glomerulonephritis (4), amyloidosis (1) and atheroembolic renal disease (1).

Conclusion

Pre-existing renal disease are frequently identified in nephrectomy specimens. FSGS was the most common diagnosis. A collaborative effort involving nephrologists, urologists and pathologists is warranted to improve the care of patients undergoing surgical nephrectomy.