AKI in the Kidney Precision Medicine Project: Acute Tubular Injury vs. Acute Interstitial Nephritis

Le résumé fourni par la source

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

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