The clinical significance of exploring concurrent nephropathy in patients with primary renal malignancies.
Patients with primary renal malignancies and nephropathy have worse outcomes, including higher mortality, than those without nephropathy.
Where it sits
this study against the rest of the ss-31 corpusSummary and findings
The study compared clinicopathological features and outcomes in 31 patients with primary renal malignancies and nephropathy (PRMN) to 31 matched controls with isolated primary renal malignancies (IPRM). PRMN patients had higher serum creatinine, lower eGFR, and more severe renal pathology. All-cause mortality was significantly higher in the PRMN group.
Abstract
<h4>Background</h4>This study aimed to compare the clinicopathological features and clinical outcomes between patients with primary renal malignancies with pathologically diagnosed nephropathy (PRMN) and those with isolated primary renal malignancies (IPRMs).<h4>Methods</h4>We enrolled 31 patients with PRMN and 31 matched controls with IPRM between 2013 and 2023. Clinical characteristics, tumour pathological features, therapeutic interventions and prognostic outcomes were systematically analysed. Nephropathy was diagnosed by immunofluorescence, immunohistochemistry and light microscopy.<h4>Results</h4>Patients in the PRMN group were younger, with a higher proportion of males and those with a smoking history. Preoperative and postoperative serum creatinine (Scr) were significantly higher in the PRMN group than in the IPRM group, while estimated glomerular filtration rate (eGFR) was significantly lower. Peritumoural renal tissues in the PRMN group showed more severe pathological changes, including global glomerulosclerosis (GS), segmental glomerulosclerosis (SS), and interstitial fibrosis and tubular atrophy (IFTA). Tumour treatment modalities did not differ significantly between groups. However, the PRMN group had a significantly higher all-cause mortality rate (19.4% vs. 0%, <i>p</i> = 0.007). Logistic regression showed that postoperative Scr (aOR = 1.176, 95% CI: 1.067-1.296; <i>p</i> = 0.001) and postoperative eGFR (aOR = 1.205, 95% CI: 1.065-1.362; <i>p</i> = 0.003) were significantly associated with PRMN. ROC analysis suggested that preoperative Scr (cutoff = 78.5 μmol/L) had diagnostic value for identifying PRMN. Kaplan-Meier's analysis showed that overall survival and composite endpoint survival were significantly lower in the PRMN group (<i>p</i> < 0.05). In exploratory Cox regression, age showed a potential association with the composite endpoint (HR = 1.138, 95% CI: 1.007-1.286, <i>p</i> = 0.038), though this finding requires validation.<h4>Conclusions</h4>Patients with PRMN exhibited distinct clinicopathological characteristics, factors associated with disease progression, and a higher incidence of adverse outcomes compared to those with IPRM.
Background
This study addresses the clinical significance of concurrent nephropathy in patients with primary renal malignancies. Prior research has not extensively explored how nephropathy affects outcomes in these patients. Understanding these relationships is crucial for improving prognostic assessments and therapeutic strategies.
Methods
The study enrolled 31 patients with primary renal malignancies and nephropathy (PRMN) and 31 matched controls with isolated primary renal malignancies (IPRM) from 2013 to 2023. Nephropathy was diagnosed using immunofluorescence, immunohistochemistry, and light microscopy. The study systematically analyzed clinical characteristics, tumor features, interventions, and outcomes.
Results
The PRMN group showed significantly higher preoperative and postoperative serum creatinine levels and lower eGFR compared to the IPRM group. Pathological changes in renal tissues, such as glomerulosclerosis and interstitial fibrosis, were more severe in PRMN. The all-cause mortality rate was significantly higher in the PRMN group at 19.4% compared to 0% in the IPRM group (p=0.007). Logistic regression indicated significant associations between postoperative Scr and eGFR with PRMN.
Interpretation
The study suggests that nephropathy in patients with primary renal malignancies is associated with worse clinical outcomes, including higher mortality. While the findings are statistically significant, the clinical implications require cautious interpretation due to the small sample size and observational nature. Further research is needed to confirm these results and explore underlying mechanisms.
Key findings
- Preoperative Scr cutoff = 78.5 μmol/L for PRMN diagnosis.
- Postoperative Scr aOR = 1.176, 95% CI: 1.067-1.296, p=0.001.
- Postoperative eGFR aOR = 1.205, 95% CI: 1.065-1.362, p=0.003.
- All-cause mortality 19.4% vs. 0%, p=0.007.
- Kaplan-Meier survival lower in PRMN, p<0.05.
Limitations
- Small sample size (n=31 per group).
- Observational study design.
- Potential confounding factors not fully controlled.
- Single-site study.
- Short follow-up duration.