A proposal for standardized grading of chronic changes in native kidney biopsy specimens

Sethi, Sanjeev; D’Agati, Vivette D.; Nast, Cynthia C.; Fogo, Agnes B.; Vriese, An S. De; Markowitz, Glen S.; Glassock, Richard J.; Fervenza, Fernando C.; Seshan, Surya V.; Rule, Andrew D.; Racusen, Lorraine C.; Radhakrishnan, Jai; Winearls, Christopher G.; Appel, Gerald B.; Bajema, Ingeborg M.; Chang, Anthony; Colvin, Robert B.; Cook, H. Terence; Hariharan, Sundaram; Hernandez, Loren P. Herrera; Kambham, Neeraja; Mengel, Michael; Nath, Karl A.; Rennke, Helmut G.; Ronco, Pierre; Rovin, Brad H.; Haas, Mark

doi:10.1016/j.kint.2017.01.002

Cited by 178 publications

(167 citation statements)

References 8 publications

(9 reference statements)

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“…In Masson trichrome stained sections, there was marked increase in collagen fibers deposition in OM-group which was in accordance with other researchers (Sethi et al, 2017, Muriithi et al, 2014) . These finding could be explained as inflammatory cells might be the physiopathological link between tubular epithelial cell injury and renal fibrosis.…”

Section: Discussionsupporting

confidence: 92%

“…However, these results disagreed with the results of other studies (Brewster and Perazella, 2007a, Geevasinga et al, 2006, Sampathkumar et al, 2013) who reported that almost uniform renal biopsy findings of extensive lymphocytic infiltrations involving the interstitium but with sparing of the glomeruli. In this study, inflammatory mononuclear cellular infiltration mainly of lymphocytes was evident which was in accordance with other studies (Sethi et al, 2017, Muriithi et al, 2014, Noone et al, 2014) , meanwhile others mentioned that the interstitial inflammation includes inflammatory cells of several types (Silva, 2004) .…”

Section: Discussionsupporting

confidence: 92%

“…Masson trichrome findings for scoring of fibrosis (Sethi et al, 2017): Score 0 : <10%, Score 1: 10–25%, Score 2: 26%–50%, and Score 3: >50% of renal cortex involved by interstitial fibrosis.…”

Section: Methodsmentioning

confidence: 99%

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Ginseng Ameliorates Effect of Prolonged Use of Omeprazole in Rat Renal Cortex through Decreasing Inflammation, Fibrosis and Apoptosis

Dayem

Saied

Ali³

et al. 2020

Preprint

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Omeprazole is used in acid-related gastrointestinal disorders but has prolonged usage adverse effects. The aim was to study changes in renal cortex following chronic Omeprazole administration and the possible protective role of ginseng. Rats were divided into control (C-), Ginseng (G-), omeprazole (OM-), and omeprazole-ginseng (OM-G) groups. Serum urea and creatinine levels and 24-hours urine-protein were determined. Kidneys were processed for histological study. Serum urea and creatinine and 24-hours protein were significantly higher in OM-group compared to controls and significantly decreased in OM-G group comparing to OM-group. OM-group showed significant glomerular and tubulointerstitial injury with vascular congestion, inflammatory cell infiltration, partial or complete damage of apical brush border of most tubules, interrupted basement membranes of glomerular capillaries and tubules, marked increase in collagen deposition, and significant increases in COX-2 and caspase-3 immune-expression. Co-administration of ginseng with omeprazole resulted in marked and significant improvement of these morphological changes. Conclusion: Omeprazole induced renal functional and morphological changes through inflammatory reaction, induction of fibrosis, cellular degeneration and apoptosis. Coadministration of ginseng ameliorated these effects through its anti-inflammatory, antifibrotic, and anti-apoptotic effects.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

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Ginseng Ameliorates Effect of Prolonged Use of Omeprazole in Rat Renal Cortex through Decreasing Inflammation, Fibrosis and Apoptosis

Dayem

Saied

Ali³

et al. 2020

Preprint

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“…Arterioles were defined as small interlobular arteries and afferent arterioles with two to three layers of smooth muscle cells . Intrarenal arteriolosclerosis was graded as follows ( Figure ) : absence of arteriolosclerosis = normal intima, moderate arteriolosclerosis = thickening of the intima with an intima/media ratio < 1, severe arteriosclerosis = thickening of the intima with an intima/media ratio ≥1; the grading of vascular lesions is based on the most severely affected arteriole in the biopsy …”

Section: Methodsmentioning

confidence: 99%

Peripheral arterial stiffness is correlated with intrarenal arteriolosclerosis according to biopsies from patients with kidney disease

Yang

Wang

et al. 2019

Nephrology

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Aim To investigate the possible associations between intrarenal arteriolosclerosis as determine by renal biopsy and endothelial function as well as arterial stiffness measured by peripheral arterial tonometry (EndoPAT). Methods This was a cross‐sectional study. Patients who underwent both renal biopsy and EndoPAT were recruited, and intrarenal arteriolosclerosis was graded according to the pathological slice. Endothelial function and arterial stiffness were both measured by EndoPAT and were expressed by the reactive hyperemia index (RHI) and augmentation index (AIx), respectively. AIx@75, representing the AIx standardized to a heart rate of 75 bpm was also determined. Results In total, 113 patients were assessed, the mean age was 51 ± 13, and 68.1% were men. The natural logarithm RHI (LnRHI), AIx and AIx@75 were significantly different among different grades of intrarenal arteriolosclerosis (P = .030, P < .001, P < .001, respectively). In the multivariable adjusted model, for every SD increase in the AIx and AIx@75, the odds of having more severe arteriolosclerosis were 2.506 times (95% confidence interval [CI] 1.464‐4.288, P = .001] and 3.191 times (95% CI 1.780‐5.719, P < .001) higher, respectively, and the association between the LnRHI and intrarenal arteriolosclerosis was nullified (P = .059). The positive values of the AIx and AIx@75 for the diagnosis of severe intrarenal arteriolosclerosis were 0.80 (95% CI 0.73‐0.88, P < .001) and 0.78 (95% CI 0.70‐0.87, P < .001), respectively. Conclusion Subjects with more severe intrarenal arteriolosclerosis have greater peripheral vascular stiffness; AIx and AIx@75 reflected peripheral vascular stiffness could be used to identify patients with severe intrarenal arteriolosclerosis.

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“…All biopsies were re‐assessed for the study by the same dedicated renal pathologist blinded to donor hypertension status. Biopsies were scored for glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriosclerosis, which was combined to a total renal chronicity score (TRCS) as proposed by Sethi et al To increase reproducibility regarding the chronic changes not elicited by alloreactivity, both preimplant and protocol biopsies were scored with the same scoring system. Acute rejection was defined according to Banff criteria on a renal biopsy pathology report .…”

Section: Methodsmentioning

confidence: 99%

Association of donor hypertension and recipient renal function in living donor kidney transplantation: A single‐center retrospective study

Dienemann

Schellenberg

Heller

et al. 2019

Clinical Transplantation

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Transplant centers now accept living donors with well‐controlled hypertension. Little is known whether hypertension in living donors affects recipient's kidney function. We aimed to examine potential differences in kidneys from hypertensive donors compared to normotensive donors with respect to renal function over 36 months and histologic findings at transplantation (T0) and 12 months after transplantation (T1). Retrospective single‐center analysis of 174 living donor‐recipient pairs (age > 18; transplantation date 1/2008‐3/2016). Hypertension in donors was defined as being on antihypertensive medication. All biopsies were assessed by the same blinded, experienced renal pathologist. Biopsies were scored for glomerulosclerosis, IFTA, and arteriosclerosis. Regression models were used to examine the relationship of donor hypertension with renal function and histologic changes. Hypertensive donors were significantly older than normotensive donors. Chronic changes such as tubular atrophy and atherosclerosis were more evident in kidneys from hypertensive donors at T0 as well as T1. Donor hypertension was independently associated with histologic changes at T0 and T1 but not with renal function over the follow period. Despite more pronounced histologic changes in kidneys from hypertensive living donors, these grafts exhibited a similar functional outcome. However, they subsequently might be at a greater risk and warrant thorough follow‐up care.

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A proposal for standardized grading of chronic changes in native kidney biopsy specimens

Cited by 178 publications

References 8 publications

Ginseng Ameliorates Effect of Prolonged Use of Omeprazole in Rat Renal Cortex through Decreasing Inflammation, Fibrosis and Apoptosis

Ginseng Ameliorates Effect of Prolonged Use of Omeprazole in Rat Renal Cortex through Decreasing Inflammation, Fibrosis and Apoptosis

Peripheral arterial stiffness is correlated with intrarenal arteriolosclerosis according to biopsies from patients with kidney disease

Association of donor hypertension and recipient renal function in living donor kidney transplantation: A single‐center retrospective study

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