Abstract: FR-PO113
Concordance of Prebiopsy and Postbiopsy Diagnosis in Patients with Suspected Acute Interstitial Nephritis or Acute Tubular Injury
Session Information
- AKI: Diagnosis and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Menez, Steven, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Hu, David, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Thiessen Philbrook, Heather, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Corona Villalobos, Celia Pamela, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Wen, Yumeng, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Parikh, Chirag R., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background
Percutaneous kidney biopsy remains the gold standard for evaluation of acute kidney injury (AKI), given that clinicians’ pre-biopsy clinical impression of AKI, based on history, exam, and non-invasive testing may often be inaccurate. In this study, we evaluated the concordance of pre-biopsy clinical diagnosis with post-biopsy final diagnosis among patients with AKI.
Methods
We leveraged data collected through the Novel Approaches in the Investigation of Kidney Disease (NAIKiD) Study between 2020 and 2023, in which adult patients admitted to the Johns Hopkins Hospital and scheduled for clinical kidney biopsies consented to provide biosamples (blood, urine, and kidney tissue) and data collection. Up to 3 pre-biopsy clinical diagnoses were recorded for each patient, along with up to 3 final diagnoses, adjudicated by a study nephrologist post-biopsy. We investigated the concordance of pre and post-biopsy diagnoses among patients with suspected acute interstitial nephritis (AIN) or acute tubular injury (ATI).
Results
Among 164 total patients, 29 patients had supsected AIN and 47 had supsected ATI pre-biopsy. Among the patients with suspected AIN, only 7 (24%) had AIN confirmed on biopsy. Of the 22 other biopsies, alternative diagnoses noted on histology included focal segmental glomerulosclerosis (FSGS), ATI, and various glomerular diseases. Out of 47 patients with suspected ATI, ATI was confirmed on biopsy in 27 (57%) patients. In the 20 biopsies without ATI, alternative diagnoses also included glomerular diseases, diabetic nephropathy, and FSGS predominantly.
Conclusion
Patients with suspected ATI or AIN who undergo percutaneous kidney biopsy are often found to have alternative, significant findings present on histology. Among inpatients without relative or absolute contraindications, kidney biopsy remains an essential part of clinical evaluation.