Evaluation nicht-neoplastischer Veränderungen des Nierenparenchyms als Prädiktoren akuter Nierenschädigung nach Nephrektomie

by Jan Michael Hähner
Doctoral thesis
Date of Examination:2025-08-13
Date of issue:2025-07-14
Advisor:PD Dr. Marianne Leitsmann
Referee:PD Dr. Marianne Leitsmann
Referee:Prof. Dr. Manuel Wallbach
Referee:Prof. Dr. Felix Bremmer
Persistent Address: http://dx.doi.org/10.53846/goediss-11364

 

 

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Abstract

English

Objective: The aim of this study was to evaluate non-neoplastic parenchymal changes in the kidney as predictors of acute kidney injury (AKI) after radical tumour nephrectomy. Methods: Data from 135 patients with renal cell carcinoma who underwent laparoscopic, open or Da Vinci robot-assisted nephrectomy between 2013 and 2018 were retrospectively analysed. The histopathological findings of the nephrectomy specimens were evaluated and divided into five groups. In addition, pre- and postoperative renal function parameters were analysed with regard to the diagnosis of AKI according to the KDIGO criteria. The non-neoplastic parenchymal changes were analysed for a possible correlation with the occurrence of postoperative AKI, as well as the occurrence of AKI in connection with demographic, preoperative and intraoperative data. Results: Overall, 44% (n=60) of patients developed AKI. Non- neoplastic parenchymal changes were detected in 35.5 % (n=48) of the nephrectomy specimens: Pyelonephritis in 17 % (n=23), glomerulosclerosis in 14 % (n=19), other fibrotic changes in 4.4 % (n=6) and diabetic nephropathies in 5 % (n=7). Nephrocalcinosis was not observed in any preparation (n=0). Although none of the parenchymal changes analysed were associated with a significantly increased risk of developing postoperative AKI , 16.3% (n=22) of patients with AKI had one of the parenchymal changes mentioned. An isolated analysis of patients with higher-grade AKI revealed the presence of pyelonephritis in all patients with grade III AKI (n=3) (100 %, p < 0.01). Conclusion: The presented analysis of non-neoplastic parenchymal changes in tumour nephrectomy specimens indicates that these changes could play a central role in estimating the risk of postoperative AKI. A significant correlation between the presence of pyelonephritis and the occurrence of AKI was found in patients with severe AKI (grade III) in particular. Even though no correlation could be shown outside this subgroup, the findings provide valuable insights into the relationships between pre- and postoperative factors and the occurrence of acute renal failure. Future studies with larger, prospective collectives could help to further validate the correlations shown here and optimise diagnostic and therapeutic practice. In view of the high incidence of postoperative AKI, such studies are essential in order to establish potential diagnostic markers for the early identification of patients at risk in everyday clinical practice and thus improve therapeutic approaches.
Keywords: Acute kidney injury (AKI); Nephrectomy; Non-neoplastic renal parenchymal changes; Glomerulosclerosis; Diabetic nephropathy; Hypertensive nephropathy; Histopathological evaluation; Chronic kidney disease (CKD); Kidney function
 
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