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A Higher Foci Density of Interstitial Fibrosis and Tubular Atrophy Predicts Progressive CKD after a Radical Nephrectomy for Tumor
Journal of the American Society of Nephrology ( IF 13.6 ) Pub Date : 2021-10-01 , DOI: 10.1681/asn.2021020267
Luisa Ricaurte Archila 1 , Aleksandar Denic 1 , Aidan F Mullan 2 , Ramya Narasimhan 1 , Marija Bogojevic 1 , R Houston Thompson 3 , Bradley C Leibovich 3 , S Jeson Sangaralingham 4 , Maxwell L Smith 5 , Mariam P Alexander 6 , Andrew D Rule 1, 7
Affiliation  

Background

Chronic tubulointerstitial injury on kidney biopsy is usually quantified by the percentage of cortex with interstitial fibrosis/tubular atrophy (IF/TA). Whether other patterns of IF/TA or inflammation in the tubulointerstitium have prognostic importance beyond percentage IF/TA is unclear.

Methods

We obtained, stained, and digitally scanned full cortical thickness wedge sections of renal parenchyma from patients who underwent a radical nephrectomy for a tumor over 2000–2015, and morphometrically analyzed the tubulointerstitium of the cortex for percentage IF/TA, IF/TA density (foci per mm2 cortex), percentage subcapsular IF/TA, striped IF/TA, percentage inflammation (both within and outside IF/TA regions), and percentage subcapsular inflammation. Patients were followed with visits every 6–12 months. Progressive CKD was defined as dialysis, kidney transplantation, or 40% decline from the postnephrectomy eGFR. Cox models assessed the risk of CKD or noncancer mortality with morphometric measures of tubulointerstitial injury after adjustment for the percentage IF/TA and clinical characteristics.

Results

Among 936 patients (mean age, 64 years; postnephrectomy baseline eGFR, 48 ml/min per 1.73m2), 117 progressive CKD events and 183 noncancer deaths occurred over a median 6.4 years. Higher IF/TA density predicted both progressive CKD and noncancer mortality after adjustment for percentage IF/TA and predicted progressive CKD after further adjustment for clinical characteristics. Independent of percentage IF/TA, age, and sex, higher IF/TA density correlated with lower eGFR, smaller nonsclerosed glomeruli, more global glomerulosclerosis, and smaller total cortical volume.

Conclusions

Higher density of IF/TA foci (a more scattered pattern with more and smaller foci) predicts higher risk of progressive CKD after radical nephrectomy compared with the same percentage of IF/TA but with fewer and larger foci.



中文翻译:

间质纤维化和肾小管萎缩的病灶密度较高预示着肿瘤根治性肾切除术后进行性 CKD

背景

肾活检的慢性肾小管间质损伤通常通过皮质间质纤维化/肾小管萎缩 (IF/TA) 的百分比来量化。IF/TA 的其他模式或肾小管间质的炎症是否具有超过 IF/TA 百分比的预后重要性尚不清楚。

方法

我们从 2000 年至 2015 年间因肿瘤接受根治性肾切除术的患者获取、染色和数字扫描肾实质的全皮质厚度楔形切片,并形态测量分析皮质肾小管间质的 IF/TA 百分比、IF/TA 密度(每毫米2皮层的病灶)、包膜下 IF/TA 百分比、条纹 IF/TA、炎症百分比(IF/TA 区域内外)和包膜下炎症百分比。每 6-12 个月对患者进行一次随访。进行性 CKD 定义为透析、肾移植或肾切除术后 eGFR 下降 40%。Cox 模型在调整 IF/TA 百分比和临床特征后,通过肾小管间质损伤的形态测量来评估 CKD 或非癌症死亡率的风险。

结果

在 936 名患者(平均年龄 64 岁;肾切除术后基线 eGFR,48 ml/min/1.73m 2)中,117 例进展性 CKD 事件和 183 例非癌症死亡发生在中位 6.4 年内。更高的 IF/TA 密度在调整 IF/TA 百分比后预测进展性 CKD 和非癌症死亡率,并在进一步调整临床特征后预测进展性 CKD。独立于 IF/TA 百分比、年龄和性别,较高的 IF/TA 密度与较低的 eGFR、较小的非硬化性肾小球、更多的全球性肾小球硬化和较小的总皮质体积相关。

结论

较高密度的 IF/TA 病灶(更分散的模式,病灶更多和更小)与相同百分比的 IF/TA 但病灶更少和更大相比,预测根治性肾切除术后进展性 CKD 的风险更高。

更新日期:2021-10-02
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