The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population.
Smoking, high consumption of fatty foods, hypertension, diabetes mellitus, obesity and decreased physical activity are considered to be risk factors for renal carcinoma (
Bladder cancer is known to be caused by the chronic inflammation associated with the presence of bladder stones (
Chronic kidney stone disease may lead to loss of kidney function and subsequent nephrectomy. Chronic kidney stone disease has been shown to be associated with transitional cell carcinoma (TCC) or renal cell carcinoma (RCC) and kidney tumors have been found to be more frequent among patients with kidney stones (
In this study, we aimed to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stones.
Between January, 2011 and June, 2014, a total of 97 patients underwent nephrectomy for non-functioning hydronephrotic kidney due to renal pelvic stones at the departments of Urology of Bozok University and Diskapi Education and Research Hospital, Turkey. The pathology reports and patient data were retrospectively reviewed.
This study's protocol was approved by the Local Ethics Committee of Bozok University (604/01-2014).
A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies.
The patient follow-up included urinary ultrasound at 1 and 3 months postoperatively and, if necessary, computed tomography or magnetic resonance imaging.
A total of 97 patients underwent nephrectomy for non-functioning hydronephrotic kidney due to renal pelvic stone disease. The mean patient age was 61.98±9.6 years. Of the 97 patients, 40 were female and 57 were male. Of the affected kidneys, 54 were on the right and 43 on the left side.
Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Among the patients with chronic pyelonephritis, 2 also had renal adenomas.
The malignant tumors included 3 TCCs, 2 squamous cell carcinomas (SCCs), 3 RCCs (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. The pathological diagnosis of the patients is summarized in
The patients were followed up for a mean of 1.4 years (range, 6 months-3 years). The patients with TCC underwent ureterectomy and bladder cuff excision as an adjuvant operation. One patient required further treatment due to metastatic disease and eventually succumbed to the disease after 11 months. A total of 3 patients required adjuvant chemotherapy and the remaining patients were disease-free at the last follow-up.
In functional kidneys, renal tumors may mimic urolithiasis and renal colic pain; therefore, they may be easier to diagnose. However, this may not be the case for non-functioning kidneys. In functioning kidneys, normal blood flow may be visualized by contrast-imaging studies, unlike non-functioning kidneys (
Patients appear to be prone to SCC following years of inflammation in the urinary tract caused by stone disease (
Several case reports have been published regarding non-functioning kidneys with kidney stones and SCC. Mathur
In 2007, Yeh
The limitations of the present study were its retrospective method and relatively small cohort.
In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as a possible malignancies, due to the the higher incidence of malignant tumors in such patients compared with the normal population. Prospective studies designed on larger cohorts are required to confirm these findings.
Pathological diagnosis in specimens of nephrectomy for non-functioning kidney due to renal pelvic stones.
| Pathological diagnosis | Patient no. | Patient age, YRS (mean ± SD) | |
|---|---|---|---|
| Chronic pyelonephritis | 79 |
57.8±8.7 | |
| Xanthogranulomatous pyelonephritis | 9 | 59.2±7.2 | |
| Malignant tumors | |||
| TCC | 3 | 60.1±10.3 | |
| RCC | 3 | 63.4±7.6 | |
| SCC | 2 | 64.6±4.5 | |
| RCC + TCC | 1 | 62 |
2 patients also had renal adenomas. SD, standard deviation; TCC, transitional cell carcinoma; RCC, renal cell carcinoma; SCC, squamous cell carcinoma.