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Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis.

Publication ,  Journal Article
Zee, J; Liu, Q; Smith, AR; Hodgin, JB; Rosenberg, A; Gillespie, BW; Holzman, LB; Barisoni, L; Mariani, LH; NEPTUNE Members, ...
Published in: J Am Soc Nephrol
July 2022

BACKGROUND: Heterogeneity in disease course and treatment response among patients with MCD/FSGS necessitates a granular evaluation of kidney tissue features. This study aimed to identify histologic and ultrastructural descriptors of structural changes most predictive of clinical outcomes in the Nephrotic Syndrome Study Network (NEPTUNE). METHODS: Forty-eight histologic (37 glomerular, 9 tubulointerstitial, 2 vascular) and 20 ultrastructural descriptors were quantified by applying the NEPTUNE Digital Pathology Scoring System to NEPTUNE kidney biopsies. Outcomes included time from biopsy to disease progression, first complete remission of proteinuria, and treatment response. Relative importance of pathology and clinical predictors was obtained from random forest models, and predictive discrimination was assessed. RESULTS: Among 224 participants (34% Black, 24% Hispanic), model performance was excellent, with predictive discrimination of 0.9 for disease progression, 0.85 for complete remission, and 0.81 for treatment response. The most predictive descriptors of outcomes included both conventional-e.g., global sclerosis or segmental sclerosis and interstitial fibrosis/tubular atrophy-and novel features, including adhesion, interstitial foam cells, deflation, periglomerular fibrosis, mononuclear white blood cells, endothelial cell abnormalities, microvillous transformation, and acute tubular injury. CONCLUSIONS: The most predictive descriptors of clinical outcomes among MCD/FSGS patients reflected structural changes in multiple renal compartments. Reporting these descriptors should be standardized to guide prognostication of proteinuric glomerular diseases.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

July 2022

Volume

33

Issue

7

Start / End Page

1411 / 1426

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sclerosis
  • Prognosis
  • Nephrotic Syndrome
  • Nephrosis, Lipoid
  • Kidney Diseases
  • Kidney
  • Humans
  • Glomerulosclerosis, Focal Segmental
  • Fibrosis
 

Citation

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Zee, J., Liu, Q., Smith, A. R., Hodgin, J. B., Rosenberg, A., Gillespie, B. W., … NEPTUNE Members, . (2022). Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis. J Am Soc Nephrol, 33(7), 1411–1426. https://doi.org/10.1681/ASN.2021101396
Zee, Jarcy, Qian Liu, Abigail R. Smith, Jeffrey B. Hodgin, Avi Rosenberg, Brenda W. Gillespie, Lawrence B. Holzman, et al. “Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis.J Am Soc Nephrol 33, no. 7 (July 2022): 1411–26. https://doi.org/10.1681/ASN.2021101396.
Zee J, Liu Q, Smith AR, Hodgin JB, Rosenberg A, Gillespie BW, et al. Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis. J Am Soc Nephrol. 2022 Jul;33(7):1411–26.
Zee, Jarcy, et al. “Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis.J Am Soc Nephrol, vol. 33, no. 7, July 2022, pp. 1411–26. Pubmed, doi:10.1681/ASN.2021101396.
Zee J, Liu Q, Smith AR, Hodgin JB, Rosenberg A, Gillespie BW, Holzman LB, Barisoni L, Mariani LH, Nephrotic Syndrome Study Network (NEPTUNE), NEPTUNE Members. Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis. J Am Soc Nephrol. 2022 Jul;33(7):1411–1426.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

July 2022

Volume

33

Issue

7

Start / End Page

1411 / 1426

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sclerosis
  • Prognosis
  • Nephrotic Syndrome
  • Nephrosis, Lipoid
  • Kidney Diseases
  • Kidney
  • Humans
  • Glomerulosclerosis, Focal Segmental
  • Fibrosis