Abstract: TH-PO1093
The Spectrum of Kidney Biopsy Findings in Dakota Native Americans
Session Information
- Pathology and Lab Medicine
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1700 Pathology and Lab Medicine
Authors
- Abdalla, Mohammed S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Nasr, Samih H., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Bu, Lihong, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kalantari, Kambiz, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Vaughan, Lisa E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
American Indians (AI) experience ESKD at 3.5 times the rate of white Americans, with diabetes accounting for 69% of new cases. However, the full pathological spectrum of kidney disease in AI, including non-diabetic renal disease (NDRD), remains poorly characterized, with prior studies limited to small southwestern populations.
Methods
All consecutive native renal biopsies from patients identifying as Native Americans from South and North Dakota (Dakota Indians), accessioned at the Mayo Clinic Laboratory from January 2018 through June 2025, were retrospectively reviewed for pathologic diagnoses, demographics, diabetes status, clinical characteristics, laboratory findings, and biopsy indications. Univariate analysis was performed to identify predictors of NDRD.
Results
Of 202 biopsies, 140 (69%) were from diabetic patients. Among 136 diabetic biopsies with adequate tissue, 56% showed diabetic nephropathy (DN) alone, 39% DN with NDRD, and 5% NDRD alone. In diabetics, the most common NDRD was acute tubular injury (ATI, 22.1%), followed by IgA nephropathy (9.6%) and infection-related glomerulonephritis (IRGN, 4.4%). In 56 non-diabetic biopsies, IgA nephropathy (25%) and IRGN (17.9%) predominated. Acute kidney injury (OR 3.31, p=0.001), positive serology (OR 2.82, p=0.006), low complement (OR 3.39, p=0.014), and positive ANA/dsDNA (OR 2.25, p=0.0496) predicted NDRD.
Conclusion
This is the largest study of kidney biopsy pathology in AI. In diabetic patients, NDRD was identified in 44% of biopsies, frequently superimposed on DN. ATI and IgA nephropathy rates exceeded those in general populations, and IRGN prevalence was notably high. These findings support a low threshold for kidney biopsy and comprehensive serologic workup in AI/AN diabetic patients, as NDRD diagnoses frequently warrant treatment changes beyond standard DN management. Our data also highlight the need to look for possible environmental and/or genetic factors contributing to the high prevalence of diseases such as IRGN and IgA nephropathy.
Funding
- Private Foundation Support