Kidney Week

Abstract: PUB181

Kidney Biopsy-Integrated Risk Model for Advanced Kidney Dysfunction in Patients with IgAN and Chronic Liver Disease: An Exploratory Study

Session Information

• Publication Only

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Kalva, Venkat Praneeth Reddy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Venkat Praneeth Reddy Kalva, MBBS

• Prathyusha, Bollam, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Bollam Prathyusha, PharmD

• Kumari, Pallavi, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Pallavi Kumari, PharmD

• Tanwar, Sonam, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Sonam Tanwar

• Kshatry, Sai Sindhu Singh, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Sai Sindhu Singh Kshatry, MD, MBBS, DM

• Reddy, Sujith, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Sujith Reddy

• Kulkarni, Anand, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Anand Kulkarni, MD, MBBS, DM

• Veeranki, Vamshidhar, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Vamshidhar Veeranki, MD, MBBS, DM

• Keithi Reddy, Sai Ram Reddy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Sai Ram Reddy Keithi Reddy, MD, DrMed

Background

Patients with IgA nephropathy (IgAN) and concurrent chronic liver disease (CLD) represent a complex dual-organ pathology population with elevated risk for advanced renal dysfunction. Risk stratification tools incorporating kidney biopsy pathology alongside hepatic parameters are lacking.

Methods

To develop an exploratory risk model integrating kidney biopsy features (interstitial fibrosis-tubular atrophy [IFTA] and crescents) with hepatic dysfunction markers for predicting advanced renal dysfunction in IgAN-CLD patients.Cross-sectional analysis of 60 biopsy-proven IgAN patients with CLD. Advanced renal dysfunction defined as serum creatinine >2.5 mg/dL OR eGFR <30 mL/min/1.73m² (n=22, 36.7%). Candidate predictors included kidney biopsy features (IFTA %, crescent grades), hepatic parameters (bilirubin, albumin, INR), and renal function markers. Logistic regression models compared hepatic-only predictors (Model 1) versus biopsy-integrated predictors (Model 2).

Results

In multivariate analysis, independent predictors included: creatinine (OR=4.8, p=0.003), bilirubin (OR=2.3, p=0.028), IFTA per 5% (OR=1.32, p=0.037), and crescents (OR=2.8, p=0.032). Model 2 (biopsy-integrated) showed numerically higher discrimination versus Model 1 (hepatic-only): AUC 0.94 vs. 0.91. A preliminary 0-40 point scoring system demonstrated sensitivity 91%, specificity 86%, NPV 96% in this derivation cohort.

Conclusion

This exploratory study suggests that kidney biopsy severity markers (IFTA and crescents) may provide incremental predictive value for advanced renal dysfunction beyond traditional hepatic parameters in IgAN-CLD patients. These hypothesis-generating findings require prospective validation in independent cohorts before clinical application.

Acknowledgment

The authors sincerely thank the nephropathology team for kidney biopsy assessment and interpretation, and the clinical and departmental staff of the Department of Nephrology and Hepatology, AIG Hospitals Gachibowli, for their support in patient care, data collection, and record maintenance. We also acknowledge the contributions of the hepatology/gastroenterology team in the evaluation and management of patients with chronic liver disease. No external funding was received for this study.

Risk Scoring

Model Performance (1 vs 2)