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REVIEW

Overdiagnosis and overtreatment of bladder and kidney lesions: Ethical and clinical lessons from past experience

Sergei V. Jargin*
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1 Department of Pathology, Faculty of Medical, Peoples’ Friendship University of Russia, Moscow 117198, Russia
Bladder, e21200072 https://doi.org/10.14440/bladder.0202
Submitted: 15 July 2025 | Revised: 17 October 2025 | Accepted: 20 October 2025 | Published: 19 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: This review summarizes previously published and recently reported findings on overdiagnosis and overtreatment with special reference to the bladder and kidney. Among others, the following is discussed: (i) overuse of cystoscopy with biopsy associated with the overdiagnosis of malignant and premalignant urinary bladder lesions after the Chernobyl accident, (ii) suppositions about increased aggressiveness of renal tumors from radiation-contaminated areas potentially conducive to overuse of nephrectomy instead of kidney-preserving surgery, (iii) wedge biopsies from the renal cortex and medulla during lithotomy, and (iv) overuse of renal biopsy and overtreatment related to it. Objective: The objective was to update the previously reported information based on the international and Russian-language literature, as well as the author’s observations. Conclusion: In conditions of paternalism, misinformation and persuasion of patients are regarded to be permissible. Suboptimal practices have been used in accordance with instructions by healthcare authorities and publications by leading experts. Collection of specimens is associated with risk, while the reliability of some studies is questionable. High quality of specimens and their examination must be a prerequisite for the use of biopsy in research and practice. In the author’s opinion, biopsy of internal organs should not be performed merely for research purposes; it must always be performed according to clinical indications. If a patient provides informed consent for research on tissues obtained for diagnostic purposes, it can be done, provided that sufficient material remains for the diagnosis. International trust and cooperation are needed to reassess potentially outdated and suboptimal methods. Authorized foreign advisors should be engaged in Russia.

Keywords
Bladder
Urothelial dysplasia
Carcinoma in situ
Lithotomy
Renal biopsy
Funding
None.
Conflict of interest
The author declares that he has no competing interests.
References
  1. Jargin SV. Selected Aspects of Healthcare in Russia. Cambridge: Cambridge Scholars Publishing; 2024.

 

  1. Epstein J. Biopsy Interpretation of the Bladder. Hagerstown: Wolters Kluwer Health; 2016.

 

  1. Romanenko A, Fukushima S. Prediction of urinary bladder cancer induction in Ukraine after the chernobyl accident. Pathol Int. 2000;50(Suppl):A70.

 

  1. Romanenko A, Morimura K, Wei M, Zaparin W, Vozianov A, Fukushima S. DNA damage repair in bladder urothelium after the Chernobyl accident in Ukraine. J Urol. 2002;168(3):973-977. doi: 10.1016/S0022-5347(05)64554-5

 

  1. Romanenko AM, Kinoshita A, Wanibuchi H, et al. Involvement of ubiquitination and sumoylation in bladder lesions induced by persistent long-term low dose ionizing radiation in humans. J Urol. 2006;175(2):739-743. doi: 10.1016/S0022-5347(05)00172-2

 

  1. Romanenko A, Kakehashi A, Morimura K, et al. Urinary bladder carcinogenesis induced by chronic exposure to persistent low-dose ionizing radiation after chernobyl accident. Carcinogenesis. 2009;30:1821-1831. doi: 10.1093/carcin/bgp193

 

  1. Jargin SV. Urological concern after nuclear accidents. Urol Ann. 2018;10(3):240-242.doi: 10.4103/0974-7796.236525

 

  1. Romanenko A, Vozianov A, Morimura K, Fukushima S. Correspondence re: W. Paile’s letter to the editor’. Cancer Res., 60: 1146, 2000. Cancer Res. 2001;61:6964-6965.

 

  1. Jargin SV. Re: Involvement of ubiquitination and sumoylation in bladder lesions induced by persistent long-term low dose ionizing radiation in humans and Re: DNA damage repair in bladder urothelium after the Chernobyl accident in Ukraine. J Urol. 2007;177(2):794; author reply 794-795. doi: 10.1016/j.juro.2006.09.087

 

  1. Romanenko A, Morimura K, Wanibuchi H, et al. Increased oxidative stress with gene alteration in urinary bladder urothelium after the Chernobyl accident. Int J Cancer. 2000;86:790-798. doi: 10.1002/(sici)1097-0215(20000615)86:6<790::aid-ijc6>3.0.co;2-q

 

  1. Romanenko AM. Chronic cystitis in the aspect of its relationship with precancerous conditions. Arkh Patol. 1982;(12):52-58.

 

  1. Romanenko AM, Klimenko IA, Iurakh GI. Leukoplakia of the bladder. Arkh Patol. 1985;47(1):52-58.

 

  1. Jargin SV. Pathology in the former soviet union: Scientific misconduct and related phenomena. Dermatol Pract Concept. 2011;1(1):75-81. doi: 10.5826/dpc.0101a16

 

  1. Romanenko A, Morell-Quadreny L, Nepomnyaschy V, Vozianov A, Llombart-Bosch A. Radiation sclerosing proliferative atypical nephropathy of peritumoral tissue of renal-cell carcinomas after the Chernobyl accdent in Ukraine. Virchows Arch. 2001;438:146-153. doi: 10.1007/s004280000334

 

  1. Morell-Quadreny L, Romanenko A, Lopez-Guerrero JA, Calabuig S, Vozianov A, Llombart-Bosch A. Alterations of ubiquitylation and sumoylation in conventional renal cell carcinomas after the Chernobyl accident: A comparison with Spanish cases. Virchows Arch. 2011;459:307-313. doi: 10.1007/s00428-011-1124-8

 

  1. Romanenko A, Morell-Quadreny L, Ramos D, Nepomnyaschiy V, Vozianov A, Llombart-Bosch A. Extracellular matrix alterations in conventional renal cell carcinomas by tissue microarray profiling influenced by the persistent, long-term, low-dose ionizing radiation exposure in humans. Virchows Arch. 2006;448:584-590. doi: 10.1007/s00428-006-0160-2

 

  1. Jargin S. Chernobyl cancer studies with overseas control: High grade vs. Late detection. Turk Patoloji Derg. 2022;38(3):297-298. doi: 10.5146/tjpath.2021.01526

 

  1. Kirillov IA. Morphogenesis of acute pyelonephritis (electron microscopic study). Arkh Patol. 1979;41(8):29-36.

 

  1. Kirillov IA. Morphogenesis of chronic pyelonephritis (electron microscopic study). Arkh Patol. 1980;42(1):38-45.

 

  1. Timoshek VM. Mportance of intraoperative renal biopsy in diagnosing pyelonephritis. Urol Nefrol (Mosk). 1973;38(2):20-24.

 

  1. Paltsev MA. Juxtaglomerular aparatus and interstitial cells of kidney medulla in hydronephrosis and chronic pyelonephritis. Arkh Patol. 1982;44(5):12-19.

 

  1. Jargin SV. Misconduct in Medical Research and Practice. New York: Nova Science Publishers; 2020.

 

  1. Kazeko NI, Zhmurov VA, Borovskii AA, et al. Lipids content in renal tissue membranes in patients with urolithiasis and secondary pyelonephritis. Urologiia. 2005;(5):56-58.

 

  1. Ratner M, Serov VV, Warschavski WA, et al. Recommendations for a clinical classification of chronic glomerulonephritis. Z Urol Nephrol. 1987;80:271-279.

 

  1. Ratner MI, Fedorova ND, Makurov AI. The tubulointerstitial changes in different clinical and morphological types of chronic glomerulonephritis. Urol Nefrol (Mosk). 1997;2:16-19.

 

  1. Varshavskiĭ VA, Proskurneva EP, Gasanov AB, Severgina LO, Shestakova LA. Subdivision of certain morphological variants of chronic glomerulonephritis. Arkh Patol. 1999;61(5):40-46.

 

  1. Chebotareva NV, Neprintseva NV, Bobkova IN, Kozlovskaia LV. Investigation of 70-kDa heat shock protein in the serum and urine of patients with chronic glomerulonephritis. Ter Arkh. 2014;86(6):18-23.

 

  1. Ratner MI, Serov VV, Varshavskiĭ VA, Brodskiĭ MA, Makurov AI. Functional and morphological characteristics of a hematuric form of chronic glomerulonephritis. Klin Med (Mosk). 1990;68(6):54-57.

 

  1. Stepanov OG. Nephrology. In: Textbook for Postgraduate Students. Maikop: Kucherenko; 2013.

 

  1. Serov VV, Pal’tsev MA, Ivanov AA, Varshavskiĭ VA. Current approaches to classification of glomerulonephritis. Arkh Patol. 1999;61(5):38-40.

 

  1. Shilov EM. Mesangioproliferative (IgA) glomerulonephritis. In: Mukhin NA, Fomin VV, editors. Nephrology. In: National Manual. Moscow: Geotar-media; 2014. p. 214-222.

 

  1. Serov VV, Varshavsky VA, Schill H, Nizze H. Incidence of glomerular diseases in kidney biopsy materials using WHO classification. Zentralbl Allg Pathol. 1986;132:471-475.

 

  1. Nizze H, Mann E, Stropahl G, Schmidt W. Glomerular diseases in renal biopsy. Correlation of clinical syndromes with histological types. Pathologe. 2003;24:421-432. doi: 10.1007/s00292-003-0647-4

 

  1. Zink CM, Ernst S, Riehl J, et al. Trends of renal diseases in Germany: Review of a regional renal biopsy database from 1990 to 2013. Clin Kidney J. 2019;12(6):795-800. doi: 10.1093/ckj/sfz023

 

  1. O’Shaughnessy MM, Hogan SL, Poulton CJ, et al. Temporal and demographic trends in glomerular disease epidemiology in the southeastern United States, 1986-2015. Clin J Am Soc Nephrol. 2017;12(4):614-623. doi: 10.2215/CJN.10871016

 

  1. Goto K, Imaizumi T, Hamada R, et al. Renal pathology in adult and paediatric population of Japan: Review of the Japan renal biopsy registry database from 2007 to 2017. J Nephrol. 2023;36(8):2257-2267. doi: 10.1007/s40620-023-01687-9

 

  1. Ratner MI, Serov VV, Varshavskii VA, et al. New classification of chronic glomerulonephritis. Klin Med (Mosk). 1987;65(4):6-11.

 

  1. Dzhanaliev BR, Varshavskii VA, Laurinavicius AA. Primary glomerulopathies: Incidence, dynamics and clinical manifestations of morphological variants. Arkh Patol. 2002;64(2):32-35.

 

  1. Shilov EM, Tareeva IE, Ivanov AA, et al. The course and prognosis of mesangioproliferative glomerulonephritis. Ter Arkh. 2002;74(6):11-18.

 

  1. United States Renal Data System (USRDS). 2022 Annual Data Report. End Stage Renal Disease: International Comparisons. Ch. 11. Available from: https://usrds/adr.niddk.nih.gov/2022/ end/stage/renal/disease/11/international/comparisons [Last accessed on 2025 Nov 14.

 

  1. Makhov VM, Abdullin RG, Gitel’ EL, et al. Visceral lesions in alcoholism. Ter Arkh. 1996;68(8):53-56.

 

  1. Lebedev SP. Klinicheskaia Morfologia Alkogolnoi Bolezni (Clinical Morphology of Alcoholic Disease). Moscow: Sechenov Medical Academy; 1985.

 

  1. Tarasova NS, Beloborodova EI. Immunological aspects of circulating immune complexes in kidney diseases in patients with chronic alcoholism. Ter Arkh. 1998;70(12):61-63.

 

  1. Tarasova NS, Beloborodova EI. Hormonal and immunological aspects of renal lesions in patients with chronic alcoholism. Ter Arkh. 2003;75(11):73-76.

 

  1. Makhov VM. Diagnostika i Lechenie Alkogol-Zavisimoi Patologii Organov Pishhevarenia (Diagnosis and Treatment of Alcohol-Dependent Pathological Conditions of the Digestive System). Moscow: Adamant; 2005.

 

  1. Severgina ES, Paltsev MA. Hypoplastic dysplasia as one of the forms of nephropathy. Arkh Patol. 1989;51(10):58-63.

 

  1. Severgina LO, Gurevich SI. Ultrastructural assessment of the role of dysangiogenesis in congenital hydronephrosis. Arkh Patol. 2014;76(6):51-55. doi: 10.17116/patol201476651-55

 

  1. Severgina ES. Ultrastructural heterogeneity of “minimal changes” in the kidney glomeruli, detected by light optics. Arkh Patol. 1991;53(2):53-58.

 

  1. Leonova LV. Pathological anatomy of congenital obstructive uropathies in children. Dissertation. Moscow: Russian State Medical University; 2009.

 

  1. Cheskis AL, Severgina ES, Leonova LV, Ostapko MS. Status and development of the kidney after surgical treatment of hydronephrosis in children. Urologiia. 2002;4:39-43.

 

  1. Leonova LV, Severgina ES, Popova OP, Konovalov DM, Petruchina IuV, Simonova NA. Transforming growth factor as a marker beta of nephrogenetic disturbance in congenital obstructive uropathies. Arkh Patol. 2007;69(4):35-38.

 

  1. Severgina LO, Leonova LV, Severgina ES, et al. Coupling between the hemodynamic parameters and the morphological changes in the kidney in children with congenital hydronephrosis. Arkh Patol. 2011;73(2):14-17.

 

  1. Severgina LO. The Role of Dysangiogenesis in Malformations of the Urogenital System. Moscow: Sechenov Medical Academy; 2014.

 

  1. Severgina ES. Morphology and Pathogenesis of Insulindependent Diabetes Mellitus. Abstract for the Higher Doctorate (Habilitation). Moscow: Sechenov Medical Academy; 1995.

 

  1. Severgina ES, Ponomarev AB, Diuzheva TG, Shestakova MV, Maĭorova EM. Diabetic glomerulonephritis--the first stage of diabetic glomerulopathy. Arkh Patol. 1994;56(4):44-50.

 

  1. Severgina ES, Ponomarev AB, Diuzheva TG, Shestakova MV, Maĭorova EM. Diabetic glomerulosclerosis--a prolonged stage of diabetic glomerulopathy. Arkh Patol. 1994;56(4):50-55.

 

  1. Paltsev MA. Morfo-Funktsionalnaya Kharakteristika Endokrinnoy Sistemy Pochek Pri Nefropatiyakh i Vasorenalnoy Gipertenzii (Morphological and Functional Characteristic of the Renal Endocrine System in Nephropathies and Renovascular Hypertension). Moscow: Sechenov Medical Academy; 1985.

 

  1. Pal’tsev MA, Iargin SV, Krotovskii GS, Turpitko SA, Mamedov DM. Importance of morphologic examination of the kidneys of patients with vasorenal hypertension for predicting the results of surgical treatment. Arkh Patol. 1986;48(6):34-40.

 

  1. Paltsev MA, Krotovski GS, Egorova IA, Shcherbiuk AN. State of the neuroendocrine aparatus of the kidney during renovascular hypertension as a criterion of the prognosis of the surgery outcome. Arkh Patol. 1982;44(8):62-71.

 

  1. Krotovskii GS, Pa’ltsev MA, Pokrovskii AV, et al. Mathematical modeling of the degree of nephroarteriolosclerosis in vasorenal hypertension. Khirurgiia (Mosk). 1989;6:23-27.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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