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Global Glomerulosclerosis in Kidney Biopsies With Differing Amounts of Cortex: A Clinical-Pathologic Correlation
Robert S Niznik1, Camden L Lopez1, Walter K Kremers1
1Divisions of Nephrology and Hypertension (RSN, AD) and Biomedical Statistics and Informatics (CLL, WKK), and Departments of Laboratory Medicine and Pathology (SS) and Surgery (MDS), Mayo Clinic, Rochester, MN; Department of Nephrology, Cleveland Clinic, Cleveland, OH (JJA); and Division of Epidemiology, Mayo Clinic, Rochester, MN (ADR).
Kidney Medicine
|July 28, 2020
Summary
Fewer glomeruli in kidney biopsies correlate with more global glomerulosclerosis and interstitial fibrosis. This suggests that low cortical amounts in kidney biopsy specimens may reflect chronic changes, impacting diagnostic accuracy.
Area of Science:
- Nephrology
- Pathology
- Medical Diagnostics
Background:
- Kidney biopsy adequacy is often assessed by glomeruli count (e.g., ≥10).
- Limited cortical tissue in biopsies is presumed to be imprecise for focal pathology detection.
Purpose of the Study:
- To investigate the relationship between the amount of cortex in kidney biopsy specimens and the presence of focal pathology.
- To assess if limited cortical tissue impacts the detection of global glomerulosclerosis, interstitial fibrosis, and arteriosclerosis.
Main Methods:
- Cross-sectional clinical-pathologic correlation study.
- Analysis of needle core biopsies from 2,915 living kidney donors.
- Beta-binomial modeling to assess glomeruli number impact on global glomerulosclerosis percentage and variability.
Main Results:
- Fewer glomeruli in biopsies were associated with a higher mean percentage and greater patient variability of global glomerulosclerosis.
- Smaller cortical volume correlated with less cortex on biopsy and increased global glomerulosclerosis.
- Lower glomeruli counts also associated with more interstitial fibrosis and arteriosclerosis.
Conclusions:
- The amount of cortex in kidney biopsies is not random and may reflect chronic changes.
- Low cortical amounts in biopsy specimens can be linked to increased global glomerulosclerosis and fibrosis.
- Findings challenge the assumption that limited cortex biopsies are always imprecise for focal pathology.
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