Unveiling the silent burden: high prevalence of occult nephropathies in radical nephrectomy specimens

Background: Chronic kidney disease (CKD) and renal cell carcinoma share a bidirectional relationship, with radical nephrectomy posing a significant risk for postoperative renal decline. This study identifies radical nephrectomy as a critical opportunity to evaluate the non-neoplastic renal parenchyma. Methods: We conducted a prospective observational study on 30 adult patients diagnosed with renal or urothelial cancer who underwent radical nephrectomy. Samples of non-neoplastic renal parenchyma were collected during surgery and analyzed using optical microscopy and immunofluorescence. Renal function was assessed pre- and postoperatively using the CKD-EPI formula. Results: = 1). Two cases (IgA nephropathy and minimal change disease) demonstrated spontaneous remission postsurgery, consistent with a paraneoplastic etiology. Conclusions: The non-neoplastic renal parenchyma in renal cell carcinoma patients frequently exhibits occult pathological changes, predominantly tubulointerstitial damage likely driven by the tumor microenvironment. The study highlights a higher-than-expected prevalence of undiagnosed nephropathies (24%), including paraneoplastic cases. Routine histological evaluation during radical nephrectomy is essential for optimizing patient management, avoiding unnecessary subsequent biopsies, and guiding therapeutic decisions in the oncological setting.