Nephrectomy: changing indications, 1960-1990

OBJECTIVE: To review the indications for nephrectomy over the period 1960-1990. PATIENTS AND METHODS: A total of 1470 nephrectomies were performed (excluding transplant-related nephrectomies) over this period. Data were collected by means of a pathology report review and the indications were classified according to aetiology. RESULTS: The total number of nephrectomies performed has not significantly changed over this 31-year period. There was a significant decrease in the number of partial nephrectomies performed and an increase in the number of nephrectomies performed for tumour. This change was equally distributed between both renal adenocarcinomas and transitional cell tumours. The number of nephrectomies for chronic pyelonephritis decreased over this period. The change seen was not as great as might have been anticipated in view of the advent of modern antibiotics. Nephrectomies performed for tuberculosis decreased, although this change was not established until the 1980s. In the 1960s and early 1970s, most tuberculous nephrectomies were performed in patients from the native community. By the 1980s, most patients in this category were from the ethnic Asian immigrant community. Nephrectomy rates for polycystic kidney and trauma remained unchanged. CONCLUSIONS: Despite changes in the investigation and management of renal tract pathologies, which contributed to a change in the indications for nephrectomy, the overall number of nephrectomies performed has remained constant over a 31-year period.