Abstract: FR-PO988
Clinicopathologic Features of CKD Kidney Precision Medicine Project (KPMP) Participants
Session Information
- Pathology and Lab Medicine - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1800 Pathology and Lab Medicine
Authors
- Narasimhan, Ramya, Boston Medical Center, Boston, Massachusetts, United States
- Caramori, M. Luiza A., Cleveland Clinic, Cleveland, Ohio, United States
- Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
- Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
- Roberts, Glenda V., Kidney Research Institute, University of Washington, Seattle, Washington, United States
- Henderson, Joel M., Boston Medical Center, Boston, Massachusetts, United States
- Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States
Group or Team Name
- Kidney Precision Medicine Project (KPMP).
Background
Patients with CKD have significant heterogeneity in the patterns of kidney (Kd) lesions. Herein, we analyzed research KPMP Kd biopsies (Bx) to determine if clinical features were associated with histopathologic patterns in CKD ppts with diabetic (DN) or vascular (VN) nephropathy.
Methods
Ppts recruited from 15 US centers underwent comprehensive clinical evaluation and research KdBx. Histopathology was assessed by two renal pathologists on whole slide images and consensus score assigned for morphologic features. Clinicopathologic diagnoses (Dx) were adjudicated by a committee of consortium members in 154 CKD Bx, and ppts assigned a primary Dx of DN, VN, “other”, or “could not determine."
Results
42% of Bx had DN and 32% had VN as primary Dx. Age was 58±12 vs. 63±11 yrs (p=0.02), and 32% vs. 10% were of Hispanic ethnicity (p=0.01) in the DN and VN cohort, respectively. UACR (median; 95%CI) was higher (p<0.005) in DN [1176 (833-2393)] vs. VN [191 (39-579) mg/g] ppts. There were no differences between DN and VN ppts in the proportion of females (45 vs.40%) and African Americans (32 vs.35%), or in BMI (32±7 vs. 30±6 Kg/m2 ) and eGFR (55±22 vs. 47±18 mL/min/1.73 m2). The presence and/or severity of global and segmental glomerulosclerosis, podocytopathy, interstitial fibrosis/tubular atrophy, and interstitial eosinophils were not different between groups, while arteriolar hyalinosis was more frequent in DN ppts (Table). Acute tubular injury was seen in the majority of DN and VN Bxs.
Conclusion
Protocol research KdBx are feasible and safe in CKD. Relative to KPMP CKD entry criteria, most ppts exhibited features of DN or VN and varying extent of chronic histopathologic changes. Unanticipated acute histopathologic changes including acute tubular injury were also commonly observed. Work is underway to further examine relationships between clinical features, histopathologic and -omics findings in KPMP ppts.
| Histopathologic Features | DN (n=65) % | VN (n=48) % | p-value |
| Interstitial fibrosis, moderate to severe | 53.9 | 39.6 | 0.18 |
| Tubular atrophy, moderate to severe | 56.9 | 41.7 | 0.12 |
| Tubular casts | 36.9 | 52.1 | 0.12 |
| Interstitial eosinophils | 18.5 | 6.3 | 0.09 |
| Arteriolar hyalinosis | 95.4 | 79.2 | 0.01 |
| Arteriosclerosis, severe | 32.3 | 45.9 | 0.21 |
DN=diabetic nephropathy; VN=vascular nephropathy
Funding
- NIDDK Support