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Abstract: TH-PO568

Accurate and Regional Assessment of Tubular Diameter Predicts Progressive CKD After Radical Nephrectomy

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Denic, Aleksandar, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Moustafa, Amr, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Gaddam, Mrunanjali, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Mullan, Aidan F., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Luehrs, Anthony C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Barisoni, Laura, Duke University, Durham, North Carolina, United States
  • Rule, Andrew D., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background

Manual morphometry of near to normal adult kidneys demonstrated that larger glomerular volume but not cross-sectional tubular area predicts progressive CKD. We hypothesized that a more accurate and regional assessment of enlarged tubular size may be prognostic for progressive CKD.

Methods

Periodic Acid Schiff-stained sections from benign parenchyma from 1453 radical nephrectomies were scanned into whole slide images. The mean true diameter of circular or oval shaped (minor axis) tubules was determined separately for proximal and distal tubular profiles in the superficial, middle, and deep cortical regions. Cox models assessed the risk of CKD progression (defined as dialysis, kidney transplantation, or a 40% decline from postnephrectomy baseline eGFR) with proximal and distal tubular diameters at different depths. Cox models were unadjusted, and adjusted for age, sex, body mass index, hypertension, diabetes, eGFR, and proteinuria.

Results

Among 1453 patients (mean age, 64 years; postnephrectomy baseline eGFR, 50.9 ml/min per 1.73 m2), 114 progressive CKD events, and 272 non-cancer deaths occurred during a median 3.4 years. As shown in the Table, larger proximal tubular diameter predicted CKD progression only in the superficial cortex; while larger distal tubular diameter predicted CKD progression in all cortical regions, though, more strongly in the superficial cortex. None of the tubular measures predicted non-cancer mortality.

Conclusion

Measurement of average proximal and distal tubular diameters separately at different depths was predictive of progressive CKD. Tubular hypertrophy of more distal nephron segments in the superficial cortex appears to be more prognostic of progressive CKD than deeper tubules and more proximal segments.

Funding

  • NIDDK Support