Journal List > Korean J Urol > v.48(8) > 1004975

Cho and Kim: Analysis of the Causes of Nephrectomy in 1980–2005

Abstract

Purpose

Neoplastic, infectious and calculous diseases, as well as congenital anomaly and vascular disorder of the kidney, are known to be the main indications of a nephrectomy. However, the incidences of a nephrectomy in various renal diseases differ with respect to several factors, such as the socioeconomic situation, and differences in time and regions. This study was performed to investigate the changes of the causes of a nephrectomy and the associated factors between 1980 and 2005.

Materials and Methods

All 116,535 in-patients admitted to the Urological Department of Kangnam Sacred Heart Hospital from 1980 to 2005 were enrolled in this study, and divided into 3 groups, Period I from January 1980 to December 1987, Period II from January 1990 to December 1997, and Period III from January 2000 to December 2005. Of these patients, 11,565 (9.9%) underwent urological operations, and 234 (2.0%) were treated with a nephrectomy for various renal diseases.

Results

The causes for the nephrectomy in Period I were renal stones (30%), infection-inflammatory diseases (28.75%), congenital anomalies (15%), renal tumors (13.75%), renal injuries (10%), but tumors (41.7%), renal stones (21.4%), congenital anomalies (19.05%), infection-inflammatory diseases (8.3%) and renal injuries (5.6%) in Period II, and tumors (57.1%), congenital anomalies (17.1%), renal stones (14.3%), infection-inflammatory diseases (8.57%) and renal injuries (1.4%) in Period III, in that order (p<0.001).

Conclusions

The incidence of renal tumors has increased, but those of infection-inflammatory diseases and renal injuries have decreased. Among the renal diseases requiring a nephrectomy, renal tumors were ranked in first position, but the nephrectomy rate for benign renal diseases has markedly decreased over time, which is similar to that of developed countries.

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Table 1.
The incidences of renal diseases in in-patients
Disease Tumor∗ Inflammation∗ Stone∗ Injury∗ Congenital anomaly∗ Total
Non-Tbc Tuberculosis
    106 (0.3)        
Period I (n=34,845) 25 (0.07)     127 (0.36) 47 (0.13) 38 (0.1) 343 (0.98)
    60 (0.17) 46 (0.13)        
    97 (0.21)        
Period II (n=44,505) 86 (0.2)     205 (0.46) 69 (0.16) 183 (0.4) 640 (1.44)
    48 (0.1) 49 (0.1)        
    89 (0.23)        
Period III (n=37,185) 108 (0.29)     152 (0.4) 29 (0.08) 209 (0.56) 587 (1.58)
    27 (0.07) 62 (0.16)        

: change is statistically significant in chi-square test (p<0.01), (): %

Table 2.
The numbers of nephrectomies in in-patients
Period No. of In-patients No. of operated patients (%) No. of nephrectomy (%) p-value∗
I 34,845 4,106 (11.8) 80 (1.95)  
II 44,505 3,738 (8.4) 84 (2.25) 0.4866
III 37,185 3,721 (10.0) 70 (1.88)  
Total 116,535 11,565 (9.9) 234 (2.0)  

: chi-square test

Table 3.
Clinical characteristics of the nephrectomized patients
  Period I Period II Period III p-value
No. of patient 80 84 70  
Mean age 39.06±14.71 48.79±17.76 53.44±17.05 <0.001∗
(years)        
Male/Female 42/38 44/40 39/31 0.906
  (1.11:1) (1.1:1) (1.26:1)  
Right/Left 41/39 51/33 28/42 0.513

: ANOVA test,

: chi-square test

Table 4.
The primary diseases of the nephrectomized kidneys
Disease No. of patients (%) p-value∗
Period I Period II Period III
Tumor 11 (13.75) 35 (41.7) 40 (57.1) <0.001
Inflammation 23 (28.75) 7 (8.3) 6 (8.57) <0.001
Tuberculosis 18 (22.5) 4 (4.94) 3 (4.3)  
Renal stone 24 (30.0) 18 (21.4) 10 (14.3) <0.001
Injury 8 (10.0) 5 (5.95) 1 (1.43) <0.001
Congenital 12 (15.0) 16 (19.05) 12 (17.1) <0.001
anomaly        
Others 2 (2.5) 3 (3.6) 1 (1.4) <0.001
Total 80 (100) 84 (100) 70 (100)  

: chi-square test,

: the numbers included in inflammation

Table 5.
The rate of nephrectomies according to renal diseases
Disease No. of nephrectomy/No. of total patients (%)
Period Tumor Inflammation∗ [Tuberculosis] Renal stone∗ Injury Congenital anomaly Total∗
Period I 11/25 (44.0) 23/106 (21.7) 18/46 (39.1) 24/127 (18.9) 8/47 (17.0) 12/38 (31.6) 80/343 (23.3)
Period II 35/86 (40.69) 7/97 (7.2) 4/49 (8.2) 18/205 (8.78) 5/69 (7.2) 16/183 (8.7) 84/640 (13.1)
Period III 40/108 (37.0) 6/89 (6.7) 3/62 (4.8) 10/152 (6.58) 1/29 (3.4) 12/209 (5.7) 70/587 (11.9)
p-value 0.441 0.009 <0.0001 <0.0001 0.049 0.442 <0.0001

: change is statistically significant in chi-square test,

: change is statistically significant in Fisher's exact test

Table 6.
The numbers of the renal diseases as the cause of a nephrectomy according to age
Age (years) Renal disease Period I Period II Period III Total
0–20 Tumor   1 1 2
(n=16) Inflammation 2     2
  Injury 4 2 1 7
  Congenital anomaly 1 4   5
21–40 Tumor 3 3 6 12
(n=61) Inflammation 14 1 2 17
  Injury 2 1   3
  Stone 8 4 1 13
  Congenital anomaly 5 4 5 14
  Renal artery stenosis 1 1   2
41–60 Tumor 6 20 17 43
(n=105) Inflammation 9 2 3 14
  Stone 14 10 4 28
  Injury 2 2   4
  Congenital anomaly 3 6 4 13
  Renal artery stenosis   2   2
  Hematuria 1     1
61–80 Tumor 2 13 16 31
(n=52) Inflammation 1 2 1 4
  Stone 2 4 5 11
  Congenital anomaly 0 2 3 5
  Renal artery stenosis 0 0 1 1
Total (n)   80 84 70 234
Table 7.
Review of the literature on nephrectomies in Korea
Year Author No. of cases Prevalent age Order of causes of nephrectomy (%)
1st 2nd 3rd
1981 Kim8 51 4th. decade Tuberculosis (33.3) Stone (29.4) Injury (13.7)
1981 Choi11 58 3rd. decade Tuberculosis (58.6) Hydronephrosis (12.0) Injury (10.4)
1981 Choi10 76 3rd. decade Tuberculosis (40.8) Stone (17.2) Tumor (10.5)
1982 Kim7 114 4th. decade Tuberculosis (30.7) Tumor (18.4) Stone (17.5)
1982 Choi12 70 5th. decade Tuberculosis (25.7) Stone (24.3) Injury (14.3)
1982 Lee2 171 3rd. decade Tumor (25.1) Injury (23.4) Tuberculosis (19.3)
1982 Lee9 63 3rd–5th decade Tuberculosis (31.7) Infection (15.9) Hydronephrosis (12.8)
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