Morphometric analysis of chronicity on kidney biopsy: a useful prognostic exercise

Asghar, Muhammad S; Denic, Aleksandar; Rule, Andrew D

doi:10.1093/ckj/sfad226

Clinical Kidney Journal

2024

DOI: 10.1093/ckj/sfad226

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Morphometric analysis of chronicity on kidney biopsy: a useful prognostic exercise

Muhammad S Asghar,

Aleksandar Denic,

Andrew D Rule

Abstract: Chronic changes on kidney biopsy specimens include increasing amounts of arteriosclerosis, glomerulosclerosis, interstitial fibrosis and tubular atrophy, enlarged nephron size, and reduced nephron number. These chronic changes are difficult to accurately assess by visual inspection but are reasonably quantified using morphometry. This review describes the various patient populations that have undergone morphometric analysis of kidney biopsies. The common approaches to morphometric analysis are described. The c… Show more

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Cited by 3 publications

References 81 publications

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MRI of kidney size matters

Niendorf,

Gladytz,

Cantow

et al. 2024

Magn Reson Mater Phy

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Objective To highlight progress and opportunities of measuring kidney size with MRI, and to inspire research into resolving the remaining methodological gaps and unanswered questions relating to kidney size assessment. Materials and methods This work is not a comprehensive review of the literature but highlights valuable recent developments of MRI of kidney size. Results The links between renal (patho)physiology and kidney size are outlined. Common methodological approaches for MRI of kidney size are reviewed. Techniques tailored for renal segmentation and quantification of kidney size are discussed. Frontier applications of kidney size monitoring in preclinical models and human studies are reviewed. Future directions of MRI of kidney size are explored. Conclusion MRI of kidney size matters. It will facilitate a growing range of (pre)clinical applications, and provide a springboard for new insights into renal (patho)physiology. As kidney size can be easily obtained from already established renal MRI protocols without the need for additional scans, this measurement should always accompany diagnostic MRI exams. Reconciling global kidney size changes with alterations in the size of specific renal layers is an important topic for further research. Acute kidney size measurements alone cannot distinguish between changes induced by alterations in the blood or the tubular volume fractions—this distinction requires further research into cartography of the renal blood and the tubular volumes.

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MRI of kidney size matters

Niendorf,

Gladytz,

Cantow

et al. 2024

Magn Reson Mater Phy

View full text Add to dashboard Cite

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Glomerular and Nephron Size and Kidney Disease Outcomes: A Comparison of Manual Versus Deep Learning Methods in Kidney Pathology

Jagtap,

Janowczyk,

Chen

et al. 2025

Kidney Medicine

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IFTA Foci Density: An Unrecognized Highly Prognostic Measurement of Fibrosis in Kidney Transplant Biopsies

Denic,

Rule,

Park

et al. 2024

Kidney360

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Background: Contraction of interstitial fibrosis/tubular atrophy (IFTA) may cause %IFTA to under-represent the severity of nephron loss. Higher density of IFTA foci is an important predictor of progressive chronic kidney disease in native kidneys independent of %IFTA. Methods: We studied kidney transplant recipients transplanted between 2000-2013 who had a 5-year surveillance kidney biopsy and subsequent follow-up. Banff ci score (interstitial fibrosis) was obtained from the pathology reports. After digitizing the biopsies, we traced cortex area and each distinct IFTA focus on a single trichrome-stained section. Percent IFTA area and IFTA foci density (count of IFTA foci/cortex area) were calculated. Cox models assessed the risk of death-censored graft failure after the 5-year biopsy with Banff ci score, morphometric %IFTA, and IFTA foci density. Results: There were 58 death-censored allograft failures among 835 kidney recipients during the 5 years of follow-up. Biopsies from grafts that failed had higher mean Banff ci score (1.5 vs 0.7, p<0.0001), %IFTA (22.2% vs 7.0%, p<0.0001), and IFTA foci density (1.3 vs. 0.4 per mm2, p<0.001). After adjusting for other Banff scores or clinical variables, Banff ci did not correlate with allograft failure, but both higher %IFTA (HR=1.56, p<0.0001) and higher IFTA foci density (HR=2.34, p<0.001) did. All but 4 allograft failures by 10 years had biopsies in the top quartile of either %IFTA or IFTA foci density at 5 years. A model using just these two morphometric measures without clinical characteristics resulted in a c-statistic of 0.891 with respect to allograft failure. Conclusions: Morphometric characterization of IFTA foci density is a strong predictor of death censored allograft failure not captured in current Banff classification for grading of kidney fibrosis.

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Morphometric analysis of chronicity on kidney biopsy: a useful prognostic exercise

Cited by 3 publications

References 81 publications

MRI of kidney size matters

MRI of kidney size matters

Glomerular and Nephron Size and Kidney Disease Outcomes: A Comparison of Manual Versus Deep Learning Methods in Kidney Pathology

IFTA Foci Density: An Unrecognized Highly Prognostic Measurement of Fibrosis in Kidney Transplant Biopsies

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