Clinicopathological predictors for progression of chronic kidney disease in nephrosclerosis: a biopsy-based cohort study

Abstract Background Biopsy-based studies on nephrosclerosis are lacking and the clinicopathological predictors for progression of chronic kidney disease (CKD) are not well established. Methods We retrospectively assessed 401 patients with biopsy-proven nephrosclerosis in Japan. Progression of CKD wa...

Full description

Saved in:
Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2019-07, Vol.34 (7), p.1182-1188
Main Authors: Yamanouchi, Masayuki, Hoshino, Junichi, Ubara, Yoshifumi, Takaichi, Kenmei, Kinowaki, Keiichi, Fujii, Takeshi, Ohashi, Kenichi, Mise, Koki, Toyama, Tadashi, Hara, Akinori, Shimizu, Miho, Furuichi, Kengo, Wada, Takashi
Format: Article
Language:English
Subjects:
Biomarkers - blood
Biomarkers - urine
Biopsy - methods
Creatinine - blood
Disease Progression
Female
Glomerular Filtration Rate
Humans
Kidney - pathology
Kidney Function Tests
Male
Middle Aged
Nephrosclerosis - complications
Nephrosclerosis - pathology
Predictive Value of Tests
Renal Insufficiency, Chronic - etiology
Renal Insufficiency, Chronic - pathology
Renal Insufficiency, Chronic - physiopathology
Retrospective Studies
Risk Factors
Urinalysis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Biopsy-based studies on nephrosclerosis are lacking and the clinicopathological predictors for progression of chronic kidney disease (CKD) are not well established. Methods We retrospectively assessed 401 patients with biopsy-proven nephrosclerosis in Japan. Progression of CKD was defined as new-onset end-stage renal disease, decrease of estimated glomerular filtration rate (eGFR) by  ≥50% or doubling of serum creatinine, and the sub-distribution hazard ratio (SHR) with 95% confidence interval (CI) for CKD progression was determined for various clinical and histological characteristics in competing risks analysis. The incremental value of pathological information for predicting CKD progression was assessed by calculating Harrell’s C-statistics, the Akaike information criterion (AIC), net reclassification improvement and integrated discrimination improvement. Results During a median follow-up period of 5.3 years, 117 patients showed progression of CKD and 10 patients died before the defined kidney event. Multivariable sub-distribution hazards model identified serum albumin (SHR 0.48; 95% CI 0.35–0.67), hemoglobin A1c (SHR 0.71; 95% CI 0.54–0.94), eGFR (SHR 0.98; 95% CI 0.97–0.99), urinary albumin/creatinine ratio (UACR) (SHR 1.18; 95% CI 1.08–1.29), percentage of segmental/global glomerulosclerosis (%GS) (SHR 1.01; 95% CI 1.00–1.02) and interstitial fibrosis and tubular atrophy (IFTA) (SHR 1.52; 95% CI 1.20–1.92) as risk factors for CKD progression. The C-statistic of a model with only clinical variables was improved by adding %GS (0.790 versus 0.796, P 
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfy121