Predominant global glomerulosclerosis in patients of upper urinary tract urothelial carcinoma with pre-existing renal function impairment is a predictor of poor renal outcomes

Sheng-Wen Niu,Li-Tzong Chen,Shang-Jyh Hwang,Hugo You-Hsien Lin,I-Ching Kuo,Chi-Chi Hung,Wen-Jeng Wu,Yen-Yi Zhen,Mei-Chuan Kuo,Wei-Ming Li,Pin-Chia Huang,Ming-Yen Lin,Yu-Han Chang,Shih-Meng Yeh,Chun-Nung Huang,Peir-In Liang,Yi-Wen Chiu

doi:10.1186/s12885-019-5414-x

Abstract

BackgroundIncidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy.MethodsTotally 193 renal cancer patients, including 132 UTUC and 61 RCC, were studied to clarify whether the pathological changes of the kidney remnant removed from nephrectomy and the clinical factors might predict the risk of ESRD. Renal tubulointerstitial (TI) score and global glomerulosclerosis (GGS) rate were examined by one pathologist and two nephrologists independently under same histopathological criteria.ResultsThe glomerular filtration rates at the time of surgery were lower in UTUC than RCC groups (p < 0.001). Average GGS score and average TI rate were higher in UTUC than in RCC groups (p < 0.001; p < 0.001). Competitive risk factor analysis revealed that abnormal GGS rate not related to age, predominant in UTUC with pre-existing renal function impairment, was a histopathological predictor of poor renal outcomes (creatinine doubling or ESRD) within 5 years in UTUC patients.ConclusionPre-existing renal function and pathological change of kidney remnant in both UTUC and RCC have the value for prediction of renal outcomes.

Highlights

Incidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy
The proportion of women in UTUC was higher but prevalence of pre-existing chronic kidney disease (CKD) was slightly higher in UTUC men (80.7% vs 73.3%)
Our study identified that both UTUC and RCC patients after unilateral nephrectomy with abnormal global glomerulosclerosis (GGS) rate, hypertension and pre-existing CKD have higher risk of creatinine doubling or dialysis within 5 years

Summary

Introduction

Incidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy. The outcomes of renal cancers after surgical unilateral nephrectomy include patient survival and possibility of renal function deterioration to end-stage renal disease (ESRD). The status of renal function in UTUC patients after surgical intervention of unilateral nephrectomy could be of normal, or of various stages of chronic kidney disease (CKD), or progression to ESRD. AAN was reported strongly associated with the development of UTUC [9], and high incidence of urothelial cancers (UTUC and bladder cancer) were noted in ESRD patients received either renal transplantation or dialysis [10]. Clinical factors and pathological parameters were analyzed for prediction of renal survival (creatinine doubling and ESRD) after unilateral nephrectomy in groups of UTUC and RCC patients

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Results

Discussion

Conclusion