Histopathological Spectrum of Nephrectomy Specimens: Single Center Experience

Vinay KS and Sujatha Siddappa*

Received: June 19, 2018;   Published: July 05, 2018

DOI: 10.26717/BJSTR.2018.06.001350

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Abstract

Background: The kidneys are by and large a very resilient organ. The renal parenchyma though subjected to repeated trauma/insults of the noxious environment, they are the last to respond. The kidneys are affected by various disease processes some resulting in permanent damage leading to surgical removal of the organ i.e.nephrectomy. Indications for nephrectomy are varied including irreversible damage by chronic infections, obstructive causes including strictures & calculus disease, vesicouretric reflex, congenital dysplasia, nephrosclerosis, cystic disease, dysplasia’sand also severe traumatic injury, non-corrective renal artery disease leading to renovascular hypertension.Common indication for nephrectomy would be obstructive nephropathy, hydronephrosis and chronic pyelonephritis according to studies. Nephrectomy procedure may show geographic variations with variable urological causes. Indications for nephrectomy may show geographic variations with differenturologic causes in different countries worldwide.

Objective: Objective of this study is to observe the spectrum of histopathological lesions in nephrectomy cases received in our department and then to know the indications for the same in our community practice. We also studied the age and sex distribution, neoplastic and non-neoplastic distribution of cases along with other histomorphologic features. Ours is a tertiary care center in southern part of India catering to both urban and rural population.

Materials and Methods: The present study was done for a period of 1year from January 2017to January2018 which included all the nephrectomy specimen received in the department of pathology, Institute of Nephrourology, Bangalore, India. It is a retrospective study. A total of 71 nephrectomy cases were included in the study period. Patient particulars including age, sex, clinical diagnosis along with radiological details like USG and CT findings along with gross morphology and microscopic details were noted form the data available with our department. Representative bits taken were processed according to standard operating protocols. Sections were cut at 3-4 microns and stained with Hematoxylin and Eosin.PAS (Periodic acid Schiff) stain to look for fungal elements and ZN (Ziel Nielson) stain for Acid fast bacilli was done wherever needed. Immunohistochemistry (IHC) was not done.

Results: During the study period we received a total of 71 nephrectomies. Numbers ofmale patients were 38 (53.53%) and numbers of female patients were 33 (46.47%).Most common affected age group was 4th to 5th decade with 19 cases contributing to 26.76% of total cases. Least affected age group was 1st decade with only one case (1.40%). Number of non-neoplastic cases was 63 (88.73%) and neoplastic cases were 8 (11.26%). Neoplastic cases further included 25% of benign tumors and 75% of malignant tumors. Among the non-neoplastic inflammatory diseases affecting nephrectomies most common lesion was chronic pyelonephritis with hydronephrosis (32.39%). Among the malignant tumors, Clear cell renal cell carcinoma was most common tumor.

Conclusion: Nephrectomy is an accepted surgical procedure for non functioning kidneys due to various pathological disease processes. Most common affected age group was 4th to 5th decade.Non-neoplastic lesions were most common cause for nephrectomies.Chronic pyelonephritiswith hydronephrotic changes being the most common cause. Severe traumatic injuryandemphysematous pyelonephritis are relatively rarer causes. Clear cell renal cell carcinoma being the common among malignant tumors. Other benign and malignant lesions being rare.

Keywords: Nephrectomy; Chronic Pyelonephritis; Hydronephrosis; Clear Cell Renal Cell Carcinoma

Abbreviations: IHC: ImmunoHisto Chemistry; ZN: Ziel Nielson; CRCC: Clear Cell Renal Cell Carcinoma; SCC: Squamous Cell Carcinoma; TCC: Transitional Cell Carcinoma; RS: Renal Sarcoma; IFTA: Interstitial Fibrosis and Tubular Atrophy; PAS: Periodic Acid Schiff

Abstract| Introduction| Materials and Methods| Results| Discussion| Conclusion| References|