Nephrectomy for Non-Neoplastic
NEPHRECTOMY FOR NON-NEOPLASTIC DISEASE
Kidneys are occasionally resected for non-neoplastic disease. This may be done for non-functioning kidneys, cystic disease, nephrolithiasis, chronic infection, or rejected explant. Occasionally they will be morcellated. They still should be carefully inspected incase a tumor is present that wasn't expected. For the non-functioning kidney, usually the cortical-medullary junction is ill-defined. The cortex also may be very thin. For cystic disease, the cyst wall needs to be carefully inspected in case a cancer could be in a thickened area and/or papillations. For kidney stones, you should mention in they are located within the calyces, hilum or in the ureter. The rejected kidney will be hemorrhagic with possible infarcts and the cortical-medullary junction may be ill-defined. They are usually submitted without a capsule.
- Weigh and measure the specimen.
- Examine tissue for possible ureter and vascular margins. Measure the ureter for length and width. Examine the ureter for areas of stenosis or dilation as kidneys may be resected for ureteral abnormalities causing secondary renal failure. Examine the vascular system in transplant nephrectomies for any thrombi or stenosis.
- Bivalve the kidney. Inspect the cortical surface for defects or lesions. One way to bivalve the kidney is to open the ureter with scissors and then bivalve the kidney through the renal pelvis. This gives a good impression of the collecting system.
- Describe the abnormal tissue: scars, cysts, infarcts, calculi. The number present and where they are located and measurement of the abnormality. If cysts are present, sample any that are grossly thickened or otherwise suspicious. Inspect the calyces for blunting or dilation. End-stage cystic kidneys may have small cliniically unsuspected tumors which should be sampled if present.
- Describe any normal kidney present.
Sections for Histology
- 1 section of the ureter and vein and artery. Additional ureter if it is stenotic.
- 2-3 sections of abnormal kidney including the cortex, medulla and calyces.
- 1 section of cortex/medulla.
Labeled "Rejected Explant", received in formalin in a large container is a 200 gm. kidney without attached adipose, 12 x 10 x 6 cm. The ureter is 0.5 cm in length and 0.3 cm in diameter. The cortex is unremarkable. Upon sectioning, the kidney parenchyma is a hemorrhagic red-brown with an ill defined cortical-medullary junction. Multiple infarcts are noted within the medulla throughout the kidney occupying approximately 30%. The calyces are normal. No tumor or other lesions are noted.
1 A- ureter and vascular margins (ns)
1 B-D infarcted kidney to cortex (ss)
1 E- normal kidney is present (ss)
Modified February 2009