The prognostic value of histopathologic lesions in native kidney biopsy specimens: Results from the Boston kidney biopsy cohort study

Anand Srivastava, Ragnar Palsson, Arnaud D. Kaze, Margaret E. Chen, Polly Palacios, Venkata Sabbisetti, Rebecca Betensky, Theodore I. Steinman, Ravi I. Thadhani, Gearoid M. McMahon, Isaac E. Stillman, Helmut G. Rennke, Sushrut S. Waikar

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)2213-2224
Number of pages12
JournalJournal of the American Society of Nephrology
Volume29
Issue number8
DOIs
StatePublished - Aug 1 2018

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Kidney Diseases
Cohort Studies
Kidney
Biopsy
Disease Progression
Arteriolosclerosis
Confidence Intervals
Clinical Laboratory Techniques
Sclerosis
Tertiary Healthcare
Proteinuria
Proportional Hazards Models
Tertiary Care Centers
Atrophy
Observational Studies
Fibrosis
Demography
Inflammation

ASJC Scopus subject areas

  • Nephrology

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The prognostic value of histopathologic lesions in native kidney biopsy specimens : Results from the Boston kidney biopsy cohort study. / Srivastava, Anand; Palsson, Ragnar; Kaze, Arnaud D.; Chen, Margaret E.; Palacios, Polly; Sabbisetti, Venkata; Betensky, Rebecca; Steinman, Theodore I.; Thadhani, Ravi I.; McMahon, Gearoid M.; Stillman, Isaac E.; Rennke, Helmut G.; Waikar, Sushrut S.

In: Journal of the American Society of Nephrology, Vol. 29, No. 8, 01.08.2018, p. 2213-2224.

Research output: Contribution to journalArticle

Srivastava, A, Palsson, R, Kaze, AD, Chen, ME, Palacios, P, Sabbisetti, V, Betensky, R, Steinman, TI, Thadhani, RI, McMahon, GM, Stillman, IE, Rennke, HG & Waikar, SS 2018, 'The prognostic value of histopathologic lesions in native kidney biopsy specimens: Results from the Boston kidney biopsy cohort study', Journal of the American Society of Nephrology, vol. 29, no. 8, pp. 2213-2224. https://doi.org/10.1681/ASN.2017121260
Srivastava, Anand ; Palsson, Ragnar ; Kaze, Arnaud D. ; Chen, Margaret E. ; Palacios, Polly ; Sabbisetti, Venkata ; Betensky, Rebecca ; Steinman, Theodore I. ; Thadhani, Ravi I. ; McMahon, Gearoid M. ; Stillman, Isaac E. ; Rennke, Helmut G. ; Waikar, Sushrut S. / The prognostic value of histopathologic lesions in native kidney biopsy specimens : Results from the Boston kidney biopsy cohort study. In: Journal of the American Society of Nephrology. 2018 ; Vol. 29, No. 8. pp. 2213-2224.
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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.",
author = "Anand Srivastava and Ragnar Palsson and Kaze, {Arnaud D.} and Chen, {Margaret E.} and Polly Palacios and Venkata Sabbisetti and Rebecca Betensky and Steinman, {Theodore I.} and Thadhani, {Ravi I.} and McMahon, {Gearoid M.} and Stillman, {Isaac E.} and Rennke, {Helmut G.} and Waikar, {Sushrut S.}",
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T1 - The prognostic value of histopathologic lesions in native kidney biopsy specimens

T2 - Results from the Boston kidney biopsy cohort study

AU - Srivastava, Anand

AU - Palsson, Ragnar

AU - Kaze, Arnaud D.

AU - Chen, Margaret E.

AU - Palacios, Polly

AU - Sabbisetti, Venkata

AU - Betensky, Rebecca

AU - Steinman, Theodore I.

AU - Thadhani, Ravi I.

AU - McMahon, Gearoid M.

AU - Stillman, Isaac E.

AU - Rennke, Helmut G.

AU - Waikar, Sushrut S.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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.

AB - 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.

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