Abstract: TH-OR12
AKI in the Kidney Precision Medicine Project: Acute Tubular Injury vs. Acute Interstitial Nephritis
Session Information
- AKI: New Frontiers in Prognostication and Management
October 24, 2024 | Location: Room 6C, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Schaub, Jennifer A., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
- Victoria Castro, Angela Maria, Yale University, New Haven, Connecticut, United States
- Menez, Steven, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Wen, Yumeng, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Menon, Rajasree, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
- Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
- Wilson, Francis Perry, Yale University, New Haven, Connecticut, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Eadon, Michael T., Indiana University, Bloomington, Indiana, United States
- Bomback, Andrew S., Columbia University, New York, New York, United States
- Moledina, Dennis G., Yale University, New Haven, Connecticut, United States
- Cantley, Lloyd G., Yale University, New Haven, Connecticut, United States
- Palevsky, Paul M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- D'Agati, Vivette D., Columbia University, New York, New York, United States
- Randhawa, Parmjeet S., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Murugan, Raghavan, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Alpers, Charles E., University of Washington, Seattle, Washington, United States
- Kretzler, Matthias, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
- Himmelfarb, Jonathan, University of Washington, Seattle, Washington, United States
- Parikh, Chirag R., Johns Hopkins Medicine, Baltimore, Maryland, United States
Group or Team Name
- Kidney Precision Medicine Project (KPMP).
Background
Kidney biopsies are rarely obtained in patients with acute kidney injury (AKI) when the suspected diagnosis is acute tubular injury (ATI).
Methods
The Kidney Precision Medicine Project obtained non-clinically indicated kidney biopsies and independently adjudicated diagnosis based on the clinical history and pathology features. We evaluated the patient's clinical and pathologic features to correlate with adjudicated diagnosis.
Results
Of the 47 participants, the average age was 49 (+/-15) years; 72% were male and 40% were black. Clinical characteristics included hypertension (40%), diabetes (31%), and baseline eGFR was 58 (+/- 5) ml/min/1.73m2. On adjudication, 24 patients (51%) had a primary diagnosis of ATI, 12 (26%) patients had a diagnosis of acute interstitial nephritis (AIN), 6 had diabetic kidney disease and consensus could not be obtained for 5 patients for the primary diagnosis. A total of 30 biopsies were scored for histological descriptor features, and there was a significant increase in the number of interstitial WBCs (p=0.01), tubulitis (p=0.01), and lymphocytic tubulitis (p<0.01) in AIN compared to ATI, but the remaining 27 features were not different. We subsequently evaluated the clinician's pre-biopsy suspected diagnosis with the adjudicated diagnosis. Of the 24 ATI cases, ATI was suspected in 21 of them (88%); of the 12 AIN cases, ATI was suspected pre-biopsy in 8 (67%) (Figure).
Conclusion
In conclusion, kidney biopsy in the AKI setting is helpful as AIN is clinically under recognized.
Funding
- NIDDK Support