Kidney Week

Abstract: TH-PO804

Biopsy Features of Initial KPMP Participants with CKD and Diabetes or Hypertension

Session Information

• Pathology and Lab Medicine - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1800 Pathology and Lab Medicine

Authors

• Limonte, Christine P., University of Washington, Seattle, Washington, United States

Christine P. Limonte,

• Nam, Yunbi, University of Washington, Seattle, Washington, United States

Yunbi Nam,

• Laszik, Zoltan G., University of California San Francisco, San Francisco, California, United States

Zoltan G. Laszik,

• Barisoni, Laura, Duke Medicine, Durham, North Carolina, United States

Laura Barisoni,

• Henderson, Joel M., Boston University School of Medicine, Boston, Massachusetts, United States

Joel M. Henderson,

• McMahon, Gearoid M., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Gearoid M. McMahon,

• Stillman, Isaac Ely, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Isaac Ely Stillman,

• Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States

Jonathan J. Taliercio,

• Vazquez, Miguel A., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Miguel A. Vazquez,

• Berry, Brooke, University of Washington, Seattle, Washington, United States

Brooke Berry,

• Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States

Emilio D. Poggio,

• Alpers, Charles E., University of Washington, Seattle, Washington, United States

Charles E. Alpers,

• Rosas, Sylvia E., Joslin Diabetes and Endocrinology Research Center, Boston, Massachusetts, United States

Sylvia E. Rosas,

• de Boer, Ian H., University of Washington, Seattle, Washington, United States

Ian H. de Boer,

Group or Team Name

• For the Kidney Precision Medicine Project.

Background

The Kidney Precision Medicine Project (KPMP) is obtaining kidney biopsies in people with common causes of CKD and AKI for complete clinical, histopathological, and molecular characterization. Here we report findings from the first set of adjudicated CKD biopsies.

Methods

KPMP enrolled adults with CKD and diabetes or hypertension with eGFR 30-59ml/min/1.73m², UACR >30mg/g, or UPCR >150mg/g. Standardized clinicopathological adjudication by KPMP nephrologists and kidney pathologists was completed for 39 participants enrolled 2019-2022. Clinicians completed surveys to assess impacts of biopsy results on diagnosis and management.

Results

Participants’ mean age was 59 years, 59% were female. Mean eGFR was 53ml/min/1.73m² and median UACR was 96mg/g. Among participants with diabetes and CKD (N=28), 15 (54%) had a primary diagnosis of diabetic nephropathy, 3 (11%) had vascular nephrosclerosis, 2 (7%) had other glomerular diseases, and 8 (29%) participants had non-specific biopsy findings for which no primary diagnosis could be determined. Among those enrolled with hypertension and CKD (N=11), 5 (46%) had vascular nephrosclerosis and 6 (55%) had non-specific findings. A range of glomerular, tubulointerstitial, and vascular findings was observed (Table). 26% of clinicians stated results were different than expected and 77% stated results affected prognostic discussions.

Conclusion

Kidney biopsies in people with common causes of CKD show a broad range of histopathology and may have clinical utility. Unexpected and non-specific findings precluding a definitive diagnosis are often present. Biopsies influenced prognostic discussions between participants and their providers.

Funding

• NIDDK Support