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Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF).

To describe the pathological characteristics of the peritumoral non-neoplastic renal parenchyma (NNRP) and to investigate their impact on long-term renal function after partial nephrectomy. In our institutional robotic partial nephrectomy database, we identified 394 cases with pathological assessment of the NNRP and long-term postoperative renal functional follow-up. The NNRP was classified as normal (healthy renal parenchyma) or abnormal, based on the presence of arteriosclerosis, glomerulosclerosis, interstitial fibrosis, interstitial inflammation, and/or tubulopapillary hyperplasia. The primary outcome was a ≥ 20% decline in estimated glomerular filtration rate (eGFR) at 6 and 12 months after surgery. Multivariable analysis was used to assess the association between NNRP and eGFR decline, with adjustment for demographic, clinical, and tumor factors. Overall, 250 (63.5%) pathological specimens had abnormal NNRP features. The most prevalent isolated benign pathological feature was glomerulosclerosis (18.0%), followed by arteriosclerosis (16.8%), interstitial inflammation (12.4%), interstitial fibrosis (1.2%), and tubulopapillary hyperplasia (0.4%). The abnormal NNRP group was associated with older age (p = .01), preoperative diabetes mellitus (p = .01), and preoperative hypertension (p = .01). The preoperative eGFR was significantly lower in the abnormal NNRP group (p = .01). NNRP abnormalities were not significantly associated with eGFR decline at either 6 or 12 months. The only independent predictor of eGFR decline was warm ischemia time (p = .01), and this association was only observed at 12 months. NNRP features are associated with preoperative comorbidities and lower baseline eGFR; however, they are not independent predictors of long-term renal functional preservation after partial nephrectomy.