Srivastava A, et al. - Researchers investigated if histopathologic lesions on kidney biopsy provide prognostic information beyond clinical and laboratory data. They found that even after adjustment for proteinuria and eGFR, histopathologic lesions on kidney biopsy provided prognostic information across a diverse group of kidney diseases.

Methods

• This prospective, observational cohort study included 676 individuals undergoing native kidney biopsy at three tertiary care hospitals.
• Two experienced renal pathologists adjudicated biopsy specimens for semiquantitative scores in 13 categories of histopathology.
• The link between histopathologic lesions and risk of kidney disease progression (≥40% eGFR decline or RRT) was assessed using proportional hazards models.

Results

• The observed mean baseline eGFR was 57.5±36.0 ml/min per 1.73 m².
• Kidney disease progression was detected in 199 individuals during follow-up (median, 34.3 months).
• Independent association of the following lesions (hazard ratio; 95% confidence interval) with progression was observed even after adjustment for demographics, clinicopathologic diagnosis, and laboratory values: inflammation in nonfibrosed interstitium (0.52; 0.32 to 0.83), moderate and severe vs minimal interstitial fibrosis/tubular atrophy (2.14; 1.24 to 3.69 and 3.42; 1.99 to 5.87, respectively), moderate and severe vs minimal global glomerulosclerosis (2.17; 1.36 to 3.45 and 3.31; 2.04 to 5.38, respectively), moderate and severe vs minimal arterial sclerosis (1.78; 1.15 to 2.74 and 1.64; 1.04 to 2.60, respectively), and moderate and severe vs minimal arteriolar sclerosis (1.63; 1.08 to 2.46 and 2.33; 1.42 to 3.83, respectively).
• Findings revealed an independent association of an 11-point chronicity score derived from semiquantitative assessments of chronic lesions with higher risk of kidney disease progression (hazard ratio per one-point increase, 1.19; 95% confidence interval, 1.12 to 1.27).