This study evaluated the relationship between histological markers of chronic kidney damage in patients undergoing radical nephrectomy for kidney tumours and preoperative kidney function, degree of albuminuria, and changes in glomerular volume. A schema to grade chronic kidney damage could be used to identify patients at risk of developing CKD following nephrectomy. Non-neoplastic cortical tissue was sourced from 150 patients undergoing radical nephrectomy for suspected kidney cancer. This tissue was evaluated for indicators of chronic damage, specifically: glomerulosclerosis, arteriosclerosis, interstitial fibrosis, and tubular atrophy. Glomerular volume was determined using the Weibel and Gomez method. Associations between these parameters and both estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) were determined using either a Mann-Whitney U-test or a Kruskal-Wallis ANOVA. Associations between both eGFR and ACR and glomerular volume were assessed using linear regression. eGFR was inversely associated with the degree of glomerulosclerosis (p < 0.001), vascular narrowing (p = 0.002), tubular atrophy (p < 0.001), and interstitial fibrosis (p < 0.001). ACR was associated only with the degree of interstitial fibrosis (p = 0.02) and tubular atrophy (p = 0.02). Glomerular volume was greater for males, diabetics, hypertensive patients, and patients with a greater degree of interstitial fibrosis. Glomerular volume was positively associated with ACR. A schema to grade chronic damage was developed. The proposed schema is associated with baseline clinical indices of kidney function and damage. Longitudinal validation is necessary to determine the prognostic utility of this schema.
Pathology. 2018 Nov 23 [Epub ahead of print]
Robert J Ellis, Benjamin Kalma, Sharon J Del Vecchio, Danielle N Aliano, Keng Lim Ng, Goce Dimeski, Li Ma, David Guard, John F Bertram, Christudas Morais, Kimberley Oliver, Simon T Wood, Glenda C Gobe, Ross S Francis
Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia. Electronic address: ., Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia., Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia., Princess Alexandra Hospital, Brisbane, Qld, Australia., Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Vic, Australia., Princess Alexandra Hospital, Brisbane, Qld, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia; School of Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia; NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Qld, Australia.