The spectrum of biopsy-proven kidney diseases, causes, and renal outcomes in acute kidney injury patients
Open accessAbstract
Introduction: Acute kidney injury (AKI) is a group of highly heterogeneous, complicated clinical syndromes. Although kidney biopsy plays an irreplaceable role in evaluating complex AKI, a few studies have focused on the clinicopathology of AKI biopsies. This study analyzed the pathological disease spectrum, causes, and renal outcomes of biopsied AKI patients. Methods: We retrospectively included 2,027 AKI patients who underwent kidney biopsies at a national clinical research center of kidney diseases from 2013 through 2018. To compare the biopsied AKI cases without and with coexisting glomerulopathy, patients were classified into acute tubular/tubulointerstitial nephropathy-associated AKI (ATIN-AKI) and glomerular disease-associated AKI (GD-AKI) groups. Results: Of 2,027 biopsied AKI patients, 65.1% were male, with a median age of 43 years. A total of 1,590 (78.4%) patients had coexisting GD, while only 437 (21.6%) patients had ATIN alone. The AKI patients with GD mainly (53.5%) manifested as stage 1 AKI, while most ATIN-AKI patients (74.8%) had stage 3 AKI. In the ATIN-AKI group, 256 (58.6%) patients had acute interstitial nephritis (AIN), and 77 (17.6%) had acute tubular injury (ATI). ATIN-AKI was mainly caused by drugs in 85.5% of AIN and 63.6% of ATI cases, respectively. In AKI patients with coexisting GD, the leading pathological diagnoses in over 80% of patients were IgA nephropathy (IgAN, 22.5%), minimal change disease (MCD, 17.5%), focal segmental glomerulosclerosis (FSGS, 15.3%), lupus nephritis (LN, 11.9%), membranous nephropathy (MN, 10.2%), and ANCA-associated vasculitis (AAV, 4.7%). A total of 775 patients were followed up within 3 months after renal biopsy; ATIN-AKI patients achieved statistically higher complete renal recovery than the GD-AKI patients (83.5% vs. 70.5%, p < 0.001). Conclusions: Most biopsied AKI patients have coexisting GD, while ATIN alone is seen less frequently. ATIN-AKI is mainly caused by drugs. In GD-AKI patients, IgAN, MCD, FSGS, LN, MN, and AAV are the leading diagnoses. Compared to AKI patients without GD, patients with GD suffer from worse renal function recovery.
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The disparity in recovery rates might be attributable to the direct reversibility of drug effects upon cessation compared to the often-progressive nature of autoimmune or infectious etiologies.
“The disparity in recovery rates might be attributable to the direct reversibility of drug effects upon cessation compared to the often-progressive nature of autoimmune or infectious etiologies.”
From Clinicopathological Characteristics and Kidney Outcomes in Biopsy-Confirmed Acute Interstitial Nephritis (2024) · cites this paper as [2]
The Results section (Causes of ATI in AKI patients; page unavailable) reports higher complete recovery in ATIN-AKI than in glomerular disease-associated AKI, and identifies drugs as a common cause of ATIN-AKI. It does not attribute that disparity to recovery after stopping drugs or describe autoimmune or infectious etiologies as often progressive. (LLM, conf=0.84)
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References 31 · Cited by 11
Research works printed but not linked: 2
- [16]16. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012; 2:1-138.
- [30]30. Hida M, Saitoh H, Satoh T. Autopsy findings in postoperative acute renal failure patients, collected from the annuals of pathological autopsy cases in Japan. Tokai J Exp Clin Med. 1984;9(5-6):349-355.
- Authors
- Abuduwupuer, Z., Lei, Q., Liang, S., Xu, F., Liang, D., Yang, X., Liu, X., & Zeng, C.
- Affiliations
- Nanjing General Hospital of Nanjing Military Command (CN)
- Corresponding author
- Zeng, Caihong
- Venue
- Nephron
- Publisher
- S. Karger AG
- Published
- 2023
- Volume
- 147
- Issue
- 9
- Pages
- 541-549
- ISSN
- 1660-8151 (ISSN-L)
- 2235-3186
- OpenAlex
- W4366815959
- Cited by
- 11
- References
- 31
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Nephron journals/Nephron journals (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (82070793)
- Government of Jiangsu Province
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Nephrotoxicity and Medicinal Plants
- Keywords
- acute kidney injury, renal biopsy, glomerular disease, acute interstitial nephritis, acute tubular injury, drug-induced nephrotoxicity, IgA nephropathy, minimal change disease, focal segmental glomerulosclerosis, lupus nephritis, membranous nephropathy, ANCA-associated vasculitis, renal function recovery
- MeSH terms
- Adult, Biopsy, Female, Glomerulonephritis, IGA, Glomerulosclerosis, Focal Segmental, Humans, Kidney, Kidney Diseases, Male, Nephritis, Interstitial, Retrospective Studies, Acute Kidney Injury
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