Abstract
Background Few studies have evaluated whether histopathologic lesions on kidney biopsy provide prognostic information beyond clinical and laboratory data. Methods We enrolled 676 individuals undergoing native kidney biopsy at three tertiary care hospitals into a prospective, observational cohort study. Biopsy specimens were adjudicated for semiquantitative scores in 13 categories of histopathology by two experienced renal pathologists. Proportional hazards models tested the association between histopathologic lesions and risk of kidney disease progression ($40% eGFR decline or RRT). Results Mean baseline eGFR was 57.5636.0 ml/min per 1.73 m2. During follow-up (median, 34.3 months), 199 individuals suffered kidney disease progression. After adjustment for demographics, clinicopathologic diagnosis, and laboratory values, the following lesions (hazard ratio; 95% confidence interval) were independently associated with progression: inflammation in nonfibrosed interstitium (0.52; 0.32 to 0.83), moderate and severe versus minimal interstitial fibrosis/tubular atrophy (2.14; 1.24 to 3.69 and 3.42; 1.99 to 5.87, respectively), moderate and severe versus minimal global glomerulosclerosis (2.17; 1.36 to 3.45 and 3.31; 2.04 to 5.38, respectively), moderate and severe versus minimal arterial sclerosis (1.78; 1.15 to 2.74 and 1.64; 1.04 to 2.60, respectively), and moderate and severe versus minimal arteriolar sclerosis (1.63; 1.08 to 2.46 and 2.33; 1.42 to 3.83, respectively). An 11-point chronicity score derived from semiquantitative assessments of chronic lesions independently associated with higher risk of kidney disease progression (hazard ratio per one-point increase, 1.19; 95% confidence interval, 1.12 to 1.27). Conclusions Across a diverse group of kidney diseases, histopathologic lesions on kidney biopsy provide prognostic information, even after adjustment for proteinuria and eGFR.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2213-2224 |
| Number of pages | 12 |
| Journal | Journal of the American Society of Nephrology |
| Volume | 29 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2018 |
Funding
We thank the members of the laboratory of S.S.W. for their invaluable assistance in the Boston Kidney Biopsy Cohort. This study is supported by National Institutes of Health (NIH) grant R01DK093574 (to S.S.W.). A.S. was supported by NIH grant F32DK11106. S.S.W. is also supported by NIH grants U01DK085660, U01DK104308, and UG3DK114915. This work was conducted with support from Harvard Catalyst. The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. Part of this work was presented as a poster at the 2016 American Society of Nephrology Scientific Session on November 19 in Chicago, Illinois. This study is supported by National Institutes of Health (NIH) grant R01DK093574 (to S.S.W.). A.S. was supported by NIH grant F32DK11106. S.S.W. is also supported by NIH grants U01DK085660, U01DK104308, and UG3DK114915.
ASJC Scopus subject areas
- Nephrology
