A Study On Culprit Factors, Ultimately Demanding Nephrectomy.

摘要

Nephrectomy is a major operation requiring skilled and experienced hands to perform. AIMS AND OBJECTIVES: This astudy was performed to identify major culprit factors, which demands nephrectomy, at all. And to identify association between renal stone and squamous cell carcinoma, if any. MATERIALS AND METHODS: 78 cases of nephrectomy were collected over a two year study period. All cases were examined for their gross pathology and histopathogical examination was done using H& E staining. CONCLUSION: We found chronic pyelonephritis to be the most common lesion, followed byrenal cell carcinoma and pyonephrosis next in frequency. A statistically significant association was found between renal stone and squamous cell carcinoma of kidney (p=0.1814). Introduction Different types of nephrectomies can be performed for varying indications which depend on the type and site of the lesion. It can be of the following types1:1) Simple Nephrectomy: It is indicated in irreversible kidney damage due to chronic infection, obstruction, calculus disease, severe traumatic injury and selective neoplastic conditions. It is also indicated to treat reno-vascluar hypertension due to non-correctable renal artery disease or severe unilateral parenchymal disease due to nephosclerosis, pyelonephritis, reflux dysplasia and congenital dysplasia.2) Radical Nephrectomy: it is indicated in localized Renal Cell Carcinoma.3) Partial Nephrectomy: it is indicated for those cases of malignancy where radical nephrectomy renders patients anephric with subsequent immediate need for dialysis, or the patient is diabetic/atherosclerotic. It is also indicated in malignant lesions < 4 cms in size.A Brief account on the aetiological factors are as follows,1) Chronic Pyelonephritis:There are three peaks of incidence:infancy and early adulthood, women of childbearing age, and both men and women older than 60 years2. Most of the patients are asymptomatic , although some have history of frequent UTI, and still others are diagnosed incidentally on radiological investigation in patients of renal.2 Grossly, the kidneys are atrophic and show coarse fibrosis. Histology shows tubular damage, inflammation and fibrosis, with changes of thyroidisation in tubules noted frequently.2) Pyonephrosis:Patients usually present with high grade fever, chills and rigor. Urine may or may not show presence of pyuria and bacteriuria. Imaging studies show persistent echo in the inferior portion of collecting system, fluid debris level with dependent echoes that shift with positionalchanges. Grossly, kidneys are mildly enlarged and irregular, Cut surface sows multiple cystic spaces. Microscopically, extensive acute inflammatory infiltrate and areas of necrosis are seen.4 3) Tuberculous Kidney:Usually occurs in young adult males (20-40 years). Most patients are asymptomatic, on occasion have dull aching flank pain and passage of blood clot, secondary calculi or mass/debris. Grossly, the kidneys are normal on the outer surface( usually surrounded by perinepritis), which on sectioning show involved areas filled with cheesy material. Histologically, parenchyma shows fibrosis with tissue destruction and presence of epitheloid granulomas with areas of caseation necrosis.5 4) Xanthogranulomatous Pyelonephritis:Patients are usually females in the 5th to 7th decades. Urinary obstruction is invariably present, usually due to stones and the patients usually present with high grade fever, chills and flank pain. Grossly, mass occupying nature of this lesion often mimics RCC. Histologically, there is diffuse granulomatous inflammation with many foamy histiocytes and multinucleated cells.6 5) Angiomyolipoma:Most patients are adults. Usually, it is an incidental finding. Larger tumors can cause gastrointestinal symptoms and may be associated with retroperitoneal bleeding which is an indication for nephrectomy. Approximately, one third cases are associated with Tuberous Sclerosis. Grossly, kidneys are unencapsulated yello