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

BMC Cancer201919:337

https://doi.org/10.1186/s12885-019-5414-x

Received: 13 March 2018
Accepted: 27 February 2019
Published: 8 April 2019

Open Peer Review reports

Abstract

Background

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.

Methods

Totally 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.

Results

The 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.