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Publication
Kidney Histopathology and Prediction of Kidney Failure: A Retrospective Cohort
Study.
Authors Eadon MT, Schwantes-An TH, Phillips CL, Roberts AR, Greene CV, Hallab A, Hart
KJ, Lipp SN, Perez-Ledezma C, Omar KO, Kelly KJ, Moe SM, Dagher PC, El-Achkar
TM, Moorthi RN
Submitted By Submitted Externally on 12/3/2021
Status Published
Journal American journal of kidney diseases : the official journal of the National Kidney Foundation
Year 2020
Date Published 9/1/2020
Volume : Pages 76 : 350 - 360
PubMed Reference 32336487
Abstract The use of kidney histopathology for predicting kidney failure is not
established. We hypothesized that the use of histopathologic features of kidney
biopsy specimens would improve prediction of clinical outcomes made using
demographic and clinical variables alone., Retrospective cohort study and
development of a clinical prediction model., All 2,720 individuals from the
Biopsy Biobank Cohort of Indiana who underwent kidney biopsy between 2002 and
2015 and had at least 2 years of follow-up., Demographic variables, comorbid
conditions, baseline clinical characteristics, and histopathologic features.,
Time to kidney failure, defined as sustained estimated glomerular filtration
rate = 10mL/min/1.73m2., Multivariable Cox regression model with internal
validation by bootstrapping. Models including clinical and demographic variables
were fit with the addition of histopathologic features. To assess the impact of
adding a histopathology variable, the amount of variance explained (r2) and the
C index were calculated. The impact on prediction was assessed by calculating
the net reclassification index for each histopathologic variable and for all
combined., Median follow-up was 3.1 years. Within 5 years of biopsy, 411 (15.1%)
patients developed kidney failure. Multivariable analyses including demographic
and clinical variables revealed that severe glomerular obsolescence (adjusted
HR, 2.03; 95% CI, 1.51-2.03), severe interstitial fibrosis and tubular atrophy
(adjusted HR, 1.99; 95% CI, 1.52-2.59), and severe arteriolar hyalinosis
(adjusted HR, 1.53; 95% CI, 1.14-2.05) were independently associated with the
primary outcome. The addition of all histopathologic variables to the clinical
model yielded a net reclassification index for kidney failure of 5.1% (P <
0.001) with a full model C statistic of 0.915. Analyses addressing the competing
risk for death, optimism, or shrinkage did not significantly change the
results., Selection bias from the use of clinically indicated biopsies and
exclusion of patients with less than 2 years of follow-up, as well as reliance
on surrogate indicators of kidney failure onset., A model incorporating
histopathologic features from kidney biopsy specimens improved prediction of
kidney failure and may be valuable clinically. Future studies will be needed to
understand whether even more detailed characterization of kidney tissue may
further improve prognostication about the future trajectory of estimated
glomerular filtration rate.




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