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 57.5±36.0 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.

背景很少有研究评估肾脏活检的组织病理学病变是否提供临床和实验室数据以外的预后信息。

方法我们纳入了三所三级医院的676例接受了天然肾脏活检的患者，进行了一项前瞻性观察性队列研究。两名经验丰富的肾脏病理学家对活检标本在13种组织病理学中的半定量评分进行了裁决。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1.75 m ² / 57.5±36.0 ml / min。在随访中（中位34.3个月），有199名患者患有肾脏疾病。在调整了人口统计学，临床病理诊断和实验室值之后，以下病变（危险比； 95％置信区间）与进展独立相关：非纤维化间质中的炎症（0.52； 0.32至0.83），中度和重度与最小间质纤维化/肾小管萎缩（分别为2.14; 1.24至3.69和3.42; 1.99至5.87），中度和重度与最小的总体肾小球硬化（分别为2.17; 1.36至3.45和3.31; 2.04至5.38），中度和重度与最小的动脉硬化（1.78 ；分别为1.15至2.74和1.64； 1.04至2.60），以及中度和重度与小动脉硬化（分别为1.63； 1.08至2.46和2.33； 1.42至3.83）。

结论在各种肾脏疾病中，即使对蛋白尿和eGFR进行了调整，肾脏活检的组织病理学病变仍可提供预后信息。