The profiles of biopsy-proven renal tubulointerstitial lesions in patients with glomerular disease

Jin Dong; Yanqin Li; Shuling Yue; Xiaoting Liu; Long Wang; Mengqi Xiong; Guobao Wang; Sheng Nie; Xin Xu

doi:10.21037/atm-20-1669

The profiles of biopsy-proven renal tubulointerstitial lesions in patients with glomerular disease

Ann Transl Med. 2020 Sep;8(17):1066. doi: 10.21037/atm-20-1669.

Authors

Jin Dong¹, Yanqin Li¹, Shuling Yue², Xiaoting Liu², Long Wang¹, Mengqi Xiong¹, Guobao Wang¹, Sheng Nie¹, Xin Xu¹

Affiliations

¹ National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Pathology, King Medical Diagnostics Center, Guangzhou, China.

Abstract

Background: Renal tubules and interstitium are vulnerable to injury and play a central role in the progression of various chronic kidney diseases (CKDs). However, high quality epidemiologic study on the profiles of biopsy-proven tubulointerstitial lesions (TILs) is extremely limited.

Methods: We conducted a retrospective renal biopsy series including 62,569 native biopsies at 1,211 hospitals across China from 2015 to 2017. The TILs, including the shedding of tube epithelial, renal tubular atrophy, renal interstitial fibrosis, edema and inflammatory infiltration, were identified from the pathological report. We analyzed the severity and chronicity of TILs stratified by gender, age groups, biopsy indications, and concurrent glomerular diseases. We also examined the correlation between TIL and glomerulosclerosis.

Results: Of 56,880 patients with biopsy-proven glomerular disease, 79.5% had TILs. Renal interstitial inflammatory infiltration was the most common type of TIL (77.7%), followed by renal tubular atrophy (56.0%) and renal interstitial fibrosis (32.8%). Severe and chronic TILs were more common in adults than in children. The three glomerular diseases with the highest proportion of moderate-to-severe and chronic TIL were diabetic nephropathy, immunoglobulin A (IgA) nephropathy and focal segmental glomerulosclerosis. The severity of TILs was moderately correlated with glomerulosclerosis score (r=0.51). Moderate-to-severe and chronic TIL were more common in southern China. After adjusting for age, sex, hospital level, region, biopsy indication and type of concurrent glomerular diseases, adults with renal arteriole injury had a six-fold higher risk of moderate-to-severe TIL [odds ratio (OR), 7.12; 95% confidence interval (CI), 6.42 to 7.91] and a three-fold higher risk of chronic TIL (OR, 4.58; 95% CI, 4.37 to 4.79).

Conclusions: TILs were common in patients with biopsy-proven glomerular disease. The type and severity of TILs varied with age, region and concurrent glomerular diseases. Renal arteriole injury and glomerulosclerosis was associated with a significantly increased risk of TIL.

Keywords: Clinical epidemiology; glomerulosclerosis; kidney tubule; pathology injury; renal arteriole injury.