Study On The Difference Between Bilateral Renal Function And Its Influencing Factors In Patients With Unilateral Renal Pelvic Urothelial Carcinoma

Background Renal pelvic cancer is a malignant tumor that occurs in the pelvis and calyx and the main treatment is surgical resection.Radical surgery is the standard procedure for patients without distant metastasis.Whereas the patients become isolated kidney after operation,the renal function of patients is particularly important especially the function of the healthy kidney which should be closely monitored and protected.However,there are no definite research results on the difference beween bilateral renal function and its influencing factors in patients with unilateral renal pelvic urothelial carcinoma.Objective The patients with unilateral renal pelvic urothelial carcinoma in Shandong Province Hospital were investigated in a retrospective study,to investigate the difference betwee bilateral renal function and the factors affecting the renal function.Materials and Methods In this study,patients with histologically proven unilateral renal pelvic urothelial carcinoma admitted to Shandong Province Hospital from January 1,2010 to March 31,2018 were collected.Then gathering complete clinical data of included cases,including the basic information,initial appearance,history of disease and operation,history of drug use,preoperative laboratory results and imaging manifestations,operative type and postoperative histopathology.The clinical data collected were analyzed retrospectively,including comparing the differences of GFR between bilateral kidneys of all included patients,those with and without benign diseases affecting renal function,those with and without hydronephrosis,those with and without other lesions pathologically;and exploring the relationships among respective GFR and gender,age,pathological grade and pathological stage.All data were analyzed by SPSS for Windows software,using independent sample t test,single factor ANOVA test,Pearson correlation analysis,Spearman correlation analysis and so on.Results There were 65 cases being selected including 32 males and 33 females.The age ranged from 23 to 84 years,with an average age of 63.00±12.629 years.There were 38 cases without benign diseases affecting renal function and 27 cases with(14 cases with hypertension,5 cases with hypertension and diabetes,4 cases with diabetes,2 cases with polycystic kidney disease,and 2 cases with chronic nephritis).There were 45 cases without hydronephrosis and 20 cases with(17 cases with hydronephrosis on the affected side,1 case with hydronephrosis on the healthy side and 2 cases with hydronephrosis on both sides).Among all the patients included,55 cases had histologically proven unilateral renal pelvic urothelial carcinoma only,2 cases had ureteral urothelial carcinoma at the same time,1 case had ureteral urothelial carcinoma and bladder urothelial carcinoma at the same time,5 cases also had chronic nephritis;1 case also had chronic pyelonephritis and 1 case had glandular pyelonephritis.According to WHO 2004 classification criteria,17 cases had urothelial carcinoma low grade,44 cases had urothelial carcinoma high grade,and 4 cases had urothelial carcinoma most low grade local high grade.As for pathological stage,there were 21 patients with stage 1,17 patients with stage 2,17 patients with stage 3 and 10 patients with stage 4.The glomerular filtration rate of affected kidney ranged from 0 to 58.18 ml/min in all patients,with a mean of 27.041± 12.7232 ml/min.While the GFR of healthy kidney ranged from 19.3 to 78.3 ml/min,with a mean of 38.983±12.8467 ml/min.Independent sample t test with SPSS showed that the P values were all less than 0.05 in all patients included,those with and without benign diseases affecting renal function,those with and without hydronephrosis,those with and without other lesions pathologically.Therefore,it can be concluded that the GFR of affected kidney was significantly lower than that of healthy kidney in all patients with unilateral renal pelvic urothelial carcinoma,whether or not having benign diseases affecting renal function or hydronephrosis or other lesions pathologically.There was no significant difference in GFR of affected kidney among different genders,pathological grades,pathological stages and in GFR of healthy kidney among different genders and pathological grades(all P>0.05).In addition,there was no correlation between GFR of affected kidney and gender,pathological grade,pathological stage,and between GFR of healthy kidney and gender,pathological grade(all P>0.05).There was no significant difference in GFR of affected kidney among different age groups(P = 0.161>0.05),though there were significant differences in GFR of healthy kidney among different age groups(P =0.000<0.05).Moreover,there was a negative correlation between respective GFR and age(affected kidney:r=-0.251,P = 0.044<0.05;healthy kidney:r=-0.472,P =0.000<0.01).There were significant differences in GFR of healthy kidney among different pathological stages(P= 0.005<0.05).And,there was a positive correlation between GFR of healthy kidney and pathological stage(r = 0.460,P = 0.000<0.05),that is,the higher the pathological stage,the greater the GFR of healthy kidney.Conclusion The renal function of affected kidney was significantly lower than that of healthy kidney in patients with unilateral renal pelvic urothelial carcinoma,and the difference was greater in patients with hydronephrosis or combined with other lesions pathologically.The mechanism of renal function reduction on the affected side in patients with renal pelvic urothelial carcinoma is still not clear,and has no significant relationship with age,gender,pathological grade and pathological stage.