The Prognostic Value of Histopathologic Lesions in Native Kidney Biopsy Specimens: Results from the Boston Kidney Biopsy Cohort Study
| Autor: | Rebecca A. Betensky, Isaac E. Stillman, Theodore I. Steinman, Polly Palacios, Arnaud D. Kaze, Margaret E. Chen, Ragnar Palsson, Anand Srivastava, Gearoid M. McMahon, Venkata S. Sabbisetti, Helmut G. Rennke, Sushrut S. Waikar, Ravi Thadhani |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty 030232 urology & nephrology 030204 cardiovascular system & hematology Risk Assessment Gastroenterology Cohort Studies Tertiary Care Centers 03 medical and health sciences Sex Factors 0302 clinical medicine Clinical Research Internal medicine Biopsy Confidence Intervals medicine Humans Prospective Studies Renal Insufficiency Chronic Aged Proportional Hazards Models Kidney medicine.diagnostic_test Proportional hazards model business.industry Biopsy Needle Hazard ratio Age Factors General Medicine Middle Aged Prognosis medicine.disease Immunohistochemistry medicine.anatomical_structure Nephrology Multivariate Analysis Disease Progression Female Histopathology Renal biopsy business Boston Glomerular Filtration Rate Cohort study Kidney disease |
| Zdroj: | Journal of the American Society of Nephrology. 29:2213-2224 |
| ISSN: | 1533-3450 1046-6673 |
| DOI: | 10.1681/asn.2017121260 |
| Popis: | 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 57.5±36.0 ml/min per 1.73 m(2). 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. |
| Databáze: | OpenAIRE |
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