The Prognostic Value of Histopathologic Lesions in Native Kidney Biopsy Specimens: Results from the Boston Kidney Biopsy Cohort Study
The Prognostic Value of Histopathologic Lesions in Native Kidney Biopsy Specimens: Results from the Boston Kidney Biopsy Cohort Study
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DOI：
10.1681/asn.2017121260
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发表时间：
2018-08-01
影响因子：
13.6
通讯作者：
Waikar, Sushrut S.
中科院分区：
文献类型：
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作者：
Srivastava, Anand;Palsson, Ragnar;Waikar, Sushrut S.
背景 很少有研究评估肾活检的组织病理学病变是否提供临床和实验室数据之外的预后信息。方法我们将 676 名在三所三级医院接受自体肾活检的个体纳入一项前瞻性观察性队列研究。由两名经验丰富的肾脏病理学家对活检标本进行 13 个组织病理学类别的半定量评分。比例风险模型测试了组织病理学病变与肾脏疾病进展风险（40% eGFR 下降或 RRT）之间的关联。结果 平均基线 eGFR 为 57.536.0 ml/min 每 1.73 m(2)。在随访期间（中位时间 34.3 个月），199 名患者出现肾脏疾病进展。调整人口统计学、临床病理诊断和实验室值后，以下病变（风险比；95% 置信区间）与进展独立相关：非纤维化间质炎症（0.52；0.32 至 0.83），中度和重度与轻微间质纤维化/肾小管萎缩（2.14；1.24 至 3.69 和 3.42；1.99 至 5.87），中度和重度与轻度整体肾小球硬化（分别为2.17；1.36至3.45和3.31；2.04至5.38），中度和重度与轻度动脉硬化（分别为1.78；1.15至2.74和1.64；1.04至2.60），以及中度和重度与轻度小动脉硬化 （分别为 1.63；1.08 至 2.46 和 2.33；1.42 至 3.83）。慢性病变的半定量评估得出的 11 分慢性评分与肾病进展风险独立相关（每增加 1 分的风险比为 1.19；95% 置信区间为 1.12 至 1.27）。 结论 在不同的肾脏疾病组中，肾活检的组织病理学病变可提供预后信息，即使在调整蛋白尿和 eGFR 后也是如此。
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 57.536.0 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.