Kidney Week

Abstract: SA-PO908

Adjudication of Kidney Biopsy Histopathology to Establish Consensus Diagnosis of Tubulointerstitial Nephritis

Session Information

• Pathology and Lab Medicine - 2
  October 26, 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

• Sadarangani, Sagar S., Yale University School of Medicine, New Haven, Connecticut, United States

Sagar S. Sadarangani, MBBS

• Shaw, Melissa M., Yale University School of Medicine, New Haven, Connecticut, United States

Melissa M. Shaw

• Moeckel, Gilbert W., Yale University School of Medicine, New Haven, Connecticut, United States

Gilbert W. Moeckel, MD, PhD, FASN

• Kumar, Deepika, Yale University School of Medicine, New Haven, Connecticut, United States

Deepika Kumar, MD

• Kuperman, Michael Benjamin, Cleveland Clinic, Cleveland, Ohio, United States

Michael Benjamin Kuperman, MD

• Rosenberg, Avi Z., Johns Hopkins University, Baltimore, Maryland, United States

Avi Z. Rosenberg, MD, PhD

• Luciano, Randy L., Yale University School of Medicine, New Haven, Connecticut, United States

Randy L. Luciano, MD, PhD

• Menez, Steven, Johns Hopkins University, Baltimore, Maryland, United States

Steven Menez, MD

• Perazella, Mark A., Yale University School of Medicine, New Haven, Connecticut, United States

Mark A. Perazella, MD, MS, FASN

• Wilson, Francis Perry, Yale University School of Medicine, New Haven, Connecticut, United States

Francis Perry Wilson, MD, MS

• Makhijani, Amrita, Yale University School of Medicine, New Haven, Connecticut, United States

Amrita Makhijani

• Shelton, Kyra A., Yale University School of Medicine, New Haven, Connecticut, United States

Kyra A. Shelton

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States

Dennis G. Moledina, MD, PhD, FASN

Background

The absence of consensus histological criteria for tubulointerstitial nephritis (TIN) diagnosis leads to high variability and low inter-rater agreement in its reporting. Here, we establish consensus TIN diagnosis through an adjudicated process and test the association of interstitial histological features recorded on a standardized ordinal scale with TIN.

Methods

We selected biopsies from 147 participants enrolled in Yale’s kidney biobank including all biopsies with clinically reported TIN (n=106) and a subset of controls (n=41). The adjudication process included two renal pathologists independently reviewing whole slide scans of kidney biopsies, reporting their diagnosis, and rating histological features using a standardized scale. Disagreements were resolved by joint slide review or, if consensus could not be achieved, by a third pathologist. We report inter-rater agreement and test association of reported histologic features with TIN diagnosis.

Results

After independent review, the pathologists reached agreement on 111 cases (agreement, 75%; κ, 0.50; P<0.001), which increased after joint slide review to 144 cases (agreement, 98%; κ, 0.96; P<0.001). Interstitial features associated with consensus TIN diagnosis included severity of infiltrate in preserved areas and tubulitis (Table). Among the 106 biopsies that were clinically reported as TIN, consensus diagnosis was TIN in 91 (86%) and 20 were reclassified as non-AIN. Among the 41 without TIN reported clinically, 38 (93%) were adjudicated as non-AIN, where 3 (7%) were reclassified as TIN.

Conclusion

We noted moderate agreement on TIN diagnosis that improved after joint review of slides, which can be used as a gold-standard for research into diagnostic biomarkers and dysregulated pathways in TIN. Our analysis also provides preliminary data on histopathological features associated with TIN that could support future work on establishing consensus criteria for TIN diagnosis.

Funding

• NIDDK Support