More than ancillary records: clinical implications of renal pathology examination in tumor nephrectomy specimens

Abstract Background Nephrectomy is the management of choice for the treatment of renal tumors. Surgical pathologists primarily focus on tumor diagnosis and investigations relating to prognosis or therapy. Pathological changes in non-neoplastic tissue may, however, be relevant for further management and should be thoroughly assessed. Methods Here, we examined the non-neoplastic renal parenchyma in 206 tumor nephrectomy specimens for the presence of glomerular, tubulo-interstitial, or vascular lesions, and correlated them with clinical parameters and outcome of renal function. Results We analyzed 188 malignant and 18 benign or pseudo-tumorous lesions. The most common tumor type was clear cell renal cell carcinoma (CCRCC, n = 106) followed by papillary or urothelial carcinomas (n = 25). Renal pathology examination revealed the presence of kidney disease in 39 cases (18.9%). Glomerulonephritis was found in 15 cases (7.3%), and the most frequent was IgA nephropathy (n = 6; 2.9%). Vasculitis was found in two cases (0.9%). In 15 cases we found tubulo-interstitial nephritis, and in 9 severe diabetic or hypertensive nephropathy. Partial nephrectomy was not linked to better eGFR at follow-up. Age, vascular nephropathy, glomerular scarring and interstitial fibrosis were the leading independent negative factors influencing eGFR at time of surgery, whereas proteinuria was associated with reduced eGFR at 1 year. Conclusion Our large study population indicates a high incidence of renal diseases potentially relevant for the postoperative management of patients with renal neoplasia. Consistent and systematic reporting of non-neoplastic renal pathology in tumor nephrectomy specimens should therefore be mandatory.

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Nonneoplastic Renal Cortical Scarring at Tumor Nephrectomy Predicts Decline in Kidney Function

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0070-oa ◽

2013 ◽

Vol 137 (4) ◽

pp. 531-540 ◽

Cited By ~ 30

Author(s):

Steven P. Salvatore ◽

Eugene K. Cha ◽

James S. Rosoff ◽

Surya V. Seshan

Keyword(s):

Diabetic Nephropathy ◽

Renal Disease ◽

Interstitial Fibrosis ◽

Prognostic Significance ◽

Preoperative Assessment ◽

Tubular Atrophy ◽

Hypertensive Nephropathy ◽

Tumor Nephrectomy ◽

End Stage

Context.—Evaluating nontumor portions of tumor nephrectomies is useful to diagnose nonneoplastic renal disease. Objective.—To determine the medical renal disease frequency and to assess the prognostic significance of the various renal pathologic variables with long-term follow-up in tumor nephrectomy patients. Design.—We reviewed nonneoplastic kidney sections of 456 consecutive cases from 1998 to 2008. Seventy-five cases were excluded (19 tumor compression, 25 no nonneoplastic tissue, 22 embolized kidneys, 9 end stage). Special staining, immunofluorescence, and/or electron microscopy was performed where appropriate. Vascular sclerosis was scored from mild to severe; interstitial fibrosis/tubular atrophy and global glomerulosclerosis (GS) were expressed as percentages. Follow-up, minimum 12 months, was evaluated in 156 cases. All renal pathologic variables were compared with regard to change in creatinine level from preoperative assessment to follow-up. Results.—Of 381 cases, 57 had additional medical renal disease (15%), most frequently diabetic nephropathy (28) and hypertensive nephropathy (11). Postoperative creatinine levels increased significantly in patients with severe arteriosclerosis or arteriolosclerosis, >5% GS, and >10% interstitial fibrosis/tubular atrophy. Seventy-four percent of cases with additional nonneoplastic diagnoses showed severe arteriolosclerosis. Higher corresponding GS was seen in the more affected vascular cases: mean, 5.56% GS for mild versus 23% GS for severe. Three patients progressed to renal failure 1 to 4 years after nephrectomy, 2 with hypertensive nephrosclerosis and 1 with diabetic nephropathy. Conclusions.—Medical renal disease was identified in 15% of tumor nephrectomy specimens. The degrees of vascular sclerosis, GS, and interstitial fibrosis/tubular atrophy are predictive of elevated creatinine levels in postnephrectomy patients. Prognostic implications of the nontumor pathology are important in nephrectomized patients.

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Renal pathology

10.1093/med/9780198759584.003.0010 ◽

2017 ◽

Author(s):

James Carton

Keyword(s):

Kidney Disease ◽

Basement Membrane ◽

Reflux Nephropathy ◽

Kidney Injury ◽

Renal Pathology ◽

Renal Diseases ◽

Obstructive Nephropathy ◽

Hypertensive Nephropathy ◽

Membranous Glomerulopathy ◽

Post Infectious

This chapter discusses renal pathology, including acute kidney injury (AKI), chronic kidney disease (CKD), nephrotic syndrome, hereditary renal diseases, Alport’s syndrome and thin basement membrane lesion, hypertensive nephropathy, diabetic nephropathy, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous glomerulopathy, glomerulonephritis, IgA nephropathy, post-infectious glomerulonephritis, C3 glomerulopathy, anti-glomerular basement membrane disease, monoclonal gammopathy-associated kidney disease, acute tubular injury, acute tubulointerstitial nephritis, reflux nephropathy, and obstructive nephropathy.

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Single cell derived mRNA signals across human kidney tumors

10.1101/2020.03.19.998815 ◽

2020 ◽

Cited By ~ 1

Author(s):

Matthew D Young ◽

Thomas J Mitchell ◽

Lars Custers ◽

Thanasis Margaritis ◽

Francisco Morales ◽

...

Keyword(s):

Single Cell ◽

Human Cancer ◽

Human Kidney ◽

Cell Types ◽

Renal Tumors ◽

Tumor Type ◽

Kidney Tumors ◽

Cell Renal Cell Carcinoma ◽

Cellular Origin ◽

Normal Tissues

AbstractThe cellular transcriptome may provide clues into the differentiation state and origin of human cancer, as tumor cells may retain patterns of gene expression similar to the cell they derive from. Here, we studied the differentiation state and cellular origin of human kidney tumors, by assessing mRNA signals in 1,300 childhood and adult renal tumors, spanning seven different tumor types. Using single cell mRNA reference maps of normal tissues generated by the Human Cell Atlas project, we measured the abundance of reference “cellular signals” in each tumor. Quantifying global differentiation states, we found that, irrespective of tumor type, childhood tumors exhibited fetal cellular signals, thus replacing the long-held presumption of “fetalness” with a precise, quantitative readout of immaturity. By contrast, in adult cancers our assessment refuted the suggestion of dedifferentiation towards a fetal state in the overwhelming majority of cases, with the exception of lethal variants of clear cell renal cell carcinoma. Examining the specific cellular phenotype of each tumor type revealed an intimate connection between the different mesenchymal populations of the developing kidney and childhood renal tumors, whereas adult tumors mostly represented specific mature tubular cell types. RNA signals of each tumor type were remarkably uniform and specific, indicating a possible therapeutic and diagnostic utility. We demonstrated this utility with a case study of a cryptic renal tumor. Whilst not classifiable by clinical pathological work-up, mRNA signals revealed the diagnosis. Our findings provide a cellular definition of human renal tumors through an approach that is broadly applicable to human cancer.

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Magnetic resonance diffusion kurtosis imaging in differential diagnosis of benign and malignant renal tumors

Cancer Imaging ◽

10.1186/s40644-020-00369-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jianxiong Fu ◽

Jing Ye ◽

Wenrong Zhu ◽

Jingtao Wu ◽

Wenxin Chen ◽

...

Keyword(s):

Differential Diagnosis ◽

Mean Diffusivity ◽

Threshold Value ◽

Renal Tumors ◽

Diffusion Kurtosis Imaging ◽

Renal Oncocytoma ◽

Renal Angiomyolipoma ◽

Planar Imaging ◽

Cell Renal Cell Carcinoma ◽

Diffusion Kurtosis

Abstract Background Benign and malignant renal tumors share similar some imaging findings. Methods Sixty-six patients with clear cell renal cell carcinoma (CCRCC), 13 patients with renal angiomyolipoma with minimal fat (RAMF) and 7 patients with renal oncocytoma (RO) were examined. For diffusion kurtosis imaging (DKI), respiratory triggered echo-planar imaging sequences were acquired in axial plane (3 b-values: 0, 500, 1000s/mm2). Mean Diffusivity (MD), fractional Anisotropy (FA), mean kurtosis (MK), kurtosis anisotropy (KA) and radial kurtosis (RK) were performed. Results For MD, a significant higher value was shown in CCRCC (3.08 ± 0.23) than the rest renal tumors (2.93 ± 0.30 for RO, 1.52 ± 0.24 for AML, P < 0.05). The MD values were higher for RO than for AML (2.93 ± 0.30 vs.1.52 ± 0.24, P < 0.05), while comparable MD values were found between CCRCC and RO (3.08 ± 0.23 vs. 2.93 ± 0.30, P > 0.05). For MK, KA and RK, a significant higher value was shown in AML (1.32 ± 0.16, 1.42 ± 0.23, 1.41 ± 0.29) than CCRCC (0.43 ± 0.08, 0.57 ± 0.16, 0.37 ± 0.11) and RO (0.81 ± 0.08, 0.86 ± 0.16, 0.69 ± 0.08) (P < 0.05). The MK, KA and RK values were higher for RO than for CCRCC (0.81 ± 0.08 vs. 0.43 ± 0.08, 0.86 ± 0.16 vs. 0.57 ± 0.16, 0.69 ± 0.08 vs. 0.37 ± 0.11, P < 0.05). Using MD values of 2.86 as the threshold value for differentiating CCRCC from RO and AML, the best result obtained had a sensitivity of 76.1%, specificity of 72.6%. Using MK, KA and RK values of 1.19,1.13 and 1.11 as the threshold value for differentiating AML from CCRCC and RO, the best result obtained had a sensitivity of 91.2, 86.7, 82.1%, and specificity of 86.7, 83.2, 72.8%. Conclusion DKI can be used as another noninvasive biomarker for benign and malignant renal tumors’ differential diagnosis.

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Obstructive nephropathy and renal fibrosis

AJP Renal Physiology ◽

10.1152/ajprenal.00362.2001 ◽

2002 ◽

Vol 283 (5) ◽

pp. F861-F875 ◽

Cited By ~ 367

Author(s):

Saulo Klahr ◽

Jeremiah Morrissey

Keyword(s):

Renal Disease ◽

Renal Fibrosis ◽

Interstitial Fibrosis ◽

Rodent Model ◽

Renal Diseases ◽

Obstructive Nephropathy ◽

Therapeutic Approaches ◽

Cellular Events ◽

The Impact ◽

Made In

Interstitial fibrosis has a major role in the progression of renal diseases. Several animal models are available for the study of renal fibrosis. The models of aminonucleoside-induced nephrotic syndrome, cyclosporin nephrotoxicity, and passive Heyman nephritis are characterized by molecular and cellular events similar to those that occur in obstructive nephropathy. Additionally, inhibition of angiotensin-converting enzyme exerts salutary effects on the progression of renal fibrosis in obstructive nephropathy. Unilateral ureteral obstruction (UUO) has emerged as an important model for the study of the mechanisms of renal fibrosis and also for the evaluation of the impact of potential therapeutic approaches to ameliorate renal disease. Many quantifiable pathophysiological events occur over the span of 1 wk of UUO, making this an attractive model for study. This paper reviews some of the ongoing studies that utilized a rodent model of UUO. Some of the findings of the animal model have been compared with observations made in patients with obstructive nephropathy. Most of the evidence suggests that the rodent model of UUO is reflective of human renal disease processes.

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Differential Diagnosis of Renal Tumors With Clear Cytoplasm: Clinical Relevance of Renal Tumor Subclassification in the Era of Targeted Therapies and Personalized Medicine

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0085-ra ◽

2013 ◽

Vol 137 (4) ◽

pp. 467-480 ◽

Cited By ~ 31

Author(s):

Rajen Goyal ◽

Elizabeth Gersbach ◽

Ximing J. Yang ◽

Stephen M. Rohan

Keyword(s):

Renal Cell Carcinoma ◽

Differential Diagnosis ◽

Cell Carcinoma ◽

Targeted Therapies ◽

Renal Cell ◽

Clear Cell ◽

Renal Tumor ◽

Renal Tumors ◽

Cell Renal Cell Carcinoma ◽

Immunohistochemical Stains

Context.—The World Health Organization classification of renal tumors synthesizes morphologic, immunohistochemical, and molecular findings to define more than 40 tumor types. Of these, clear cell (conventional) renal cell carcinoma is the most common malignant tumor in adults and—with the exception of some rare tumors—the most deadly. The diagnosis of clear cell renal cell carcinoma on morphologic grounds alone is generally straightforward, but challenging cases are not infrequent. A misdiagnosis of clear cell renal cell carcinoma has clinical consequences, particularly in the current era of targeted therapies. Objective.—To highlight morphologic mimics of clear cell renal cell carcinoma and provide strategies to help differentiate clear cell renal cell carcinoma from other renal tumors and lesions. The role of the pathologist in guiding treatment for renal malignancies will be emphasized to stress the importance of proper tumor classification in patient management. Data Sources.—Published literature and personal experience. Conclusions.—In challenging cases, submission of additional tissue is often an inexpensive and effective way to facilitate a correct diagnosis. If immunohistochemical stains are to be used, it is best to use a panel of markers, as no one marker is specific for a given renal tumor subtype. Selection of limited markers, based on a specific differential diagnosis, can be as useful as a large panel in reaching a definitive diagnosis. For renal tumors, both the presence and absence of immunoreactivity and the pattern of labeling (membranous, cytoplasmic, diffuse, focal) are important when interpreting the results of immunohistochemical stains.

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The Relevance of Periglomerular Fibrosis in the Evaluation of Routine Needle Core Renal Biopsies

Archives of Pathology & Laboratory Medicine ◽

10.5858/2009-0484-oar1.1 ◽

2011 ◽

Vol 135 (1) ◽

pp. 117-122

Author(s):

Joseph Jenkins ◽

Sergey V. Brodsky ◽

Anjali A. Satoskar ◽

Gyongyi Nadasdy ◽

Tibor Nadasdy

Keyword(s):

Renal Function ◽

Renal Biopsy ◽

Renal Injury ◽

Interstitial Fibrosis ◽

Renal Diseases ◽

Glomerular Sclerosis ◽

Poor Renal Function ◽

Renal Biopsies ◽

Biopsy Report ◽

Relationship Of

Abstract Context—Renal interstitial fibrosis and, to a lesser extent, sclerotic glomeruli correlate with poor renal function. However, not all nonfunctional glomeruli are sclerotic. Many or most glomeruli with periglomerular fibrosis, while retaining blood flow, probably do not filter; therefore, they may not contribute to renal function. Objective—To examine the relationship of periglomerular fibrosis and the sum of globally sclerotic glomeruli and glomeruli with periglomerular fibrosis (GSG+PF) with interstitial fibrosis and renal function. Design—Native kidney biopsies from 177 patients with chronic renal injury were assessed for interstitial fibrosis, glomerular sclerosis, and GSG+PF. Renal biopsies with active or acute lesions were not included. The percentage of globally sclerotic glomeruli and GSG+PF was correlated with the degree of interstitial fibrosis and serum creatinine levels. Results—The percentage of GSG+PF correlates better with the degree of interstitial fibrosis and renal function than does the percentage of globally sclerotic glomeruli alone. This appears particularly true in chronic renal diseases of patients without diabetes. The number of globally sclerotic glomeruli correlates better with interstitial fibrosis and renal function than does the sum of globally and segmentally sclerotic glomeruli. Conclusions—The percentage of GSG+PF in a renal biopsy specimen provides a better estimate of chronic renal injury than does the percentage of sclerotic glomeruli alone, probably because many or most glomeruli with periglomerular fibrosis are nonfunctional. Therefore, we recommend that the number of glomeruli with periglomerular fibrosis also be provided in the renal biopsy report.

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Standardized reporting of monoclonal immunoglobulin–associated renal diseases: recommendations from a Mayo Clinic/Renal Pathology Society Working Group

Kidney International ◽

10.1016/j.kint.2020.03.025 ◽

2020 ◽

Vol 98 (2) ◽

pp. 310-313

Author(s):

Sanjeev Sethi ◽

Cynthia C. Nast ◽

Vivette D. D’Agati ◽

Fernando C. Fervenza ◽

Richard J. Glassock ◽

...

Keyword(s):

Mayo Clinic ◽

Working Group ◽

Renal Pathology ◽

Renal Diseases ◽

Monoclonal Immunoglobulin ◽

Standardized Reporting

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P0132DIAGNOSIS OF HYPEROXALURIA FROM RENAL BIOPSY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0132 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Marwa Omrane ◽

Raja Aoudia ◽

Mondher Ounissi ◽

Nada Sellami ◽

Mouna Jerbi ◽

...

Keyword(s):

Renal Failure ◽

Kidney Disease ◽

Renal Biopsy ◽

Kidney Biopsy ◽

Interstitial Fibrosis ◽

Renal Pathology ◽

Crystal Deposition ◽

Biopsy Specimens ◽

Initial Symptoms ◽

History Of

Abstract Background and Aims Crystal-induced kidney disease refers to kidney injury caused by intratubular crystal deposition. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. The purpose of our study is to determine the epidemiological and clinical characteristics of hyperoxaluria diagnosed from renal biopsy. Method We retrospectively reviewed all kidney biopsy specimens evaluated at renal pathology laboratory, from 1976 to 2019. The biopsy specimens were received from multiple medical department and medical centers. We studied 8900 biopsy specimens and we were focused on patients whose diagnosis of hyperoxaluria was made from renal biopsy Results We identified 25 cases (15 children and 10 adults) with a sex ratio H / F of 0.9. Mean age at diagnosis was 17.2 years old [4 months-73 years old]. Most patients were offspring of consanguineous mating (14 of 25) with intermarriage of first-degree cousins being the most common pattern. A family history of chronic kidney disease was found in 13 patients: indeterminated nephropathy (n = 6) and renal stone (n = 5) and primary hyperoxaluria (n=2). Among our patients, five had a history of urolithiasis. One patient had a history of chronic diarrhea related to Crohn's disease and one patient had a history of cephalic pancreatectomy and ileal resection. Initial symptoms and signs were dominated by renal failure (n = 25) with mean creatinine of 789.5 μmol / l [306-1832μmol / l], associated with proteinuria in 10 patients and hematuria in 11 patients. Arterial hypertension was present in 4 patients. Oligo anuria was reported in 4 patients without dilation of the urinary excretory pathways. In our patients, the diagnosis of crystalin nephropathy was revealed by renal biopsy. In one case, the diagnosis was made after renal transplant. In 4 cases the diagnosis was made by postmortem kidney biopsy. In all cases, the kidney biopsy specimen showed extensive intratubular crystal deposition and tubulointerstitial mononuclear cell infiltration with features of tubular injury and interstitial fibrosis. Examination of histologic slides showed colorless refractile crystals of polygonal appearance. Multicolored birefringence under polarized light identified these crystals as calcium oxalate. After different investigations (genetic and biological analysis), the diagnosis of hyperoxaluria was confirmed. Hyperoxaluria was primary in 23 patients and secondary in 2 patients. Conclusion Hyperoxaluria is a rare condition, often serious, involving renal prognosis and sometimes life-threatening, especially in early-onset forms. Early diagnosis and treatment should be done as soon as possible to slow the progression to end-stage renal failure. In patients with renal insufficiency, the diagnosis of hyperoxaluria is difficult. Renal biopsy can help when clinical and radiological data are not sufficient.

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Differential diagnosis of <3 cm renal tumors by ultrasonography: a rapid, quantitative, elastography self-corrected contrast-enhanced ultrasound imaging mode beyond screening

British Journal of Radiology ◽

10.1259/bjr.20190974 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20190974

Author(s):

Di Sun ◽

Qijie Lu ◽

Cong Wei ◽

Yi Li ◽

Yuanyi Zheng ◽

...

Keyword(s):

Differential Diagnosis ◽

Ultrasound Imaging ◽

Screening Method ◽

Acoustic Radiation Force Impulse ◽

Renal Tumors ◽

Diagnostic Strategy ◽

Contrast Enhanced Ultrasound ◽

Cell Renal Cell Carcinoma ◽

Contrast Enhanced ◽

Imaging Mode

Objectives: To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) ＜3 cm in size. Methods: The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. Results: In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. Conclusions: This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. Advances in knowledge: In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.

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