Abstract
BackgroundInterventional diagnostic procedures are established for several diseases in medicine. Despite the KDOQI guideline recommendation for histological diagnosis of kidney disease to enable risk stratification, its optimal time point has not been evaluated. We have therefore analyzed whether histological diagnosis of glomerulonephritis (GN) at an early stage of chronic kidney disease (CKD) is associated with different outcome compared to diagnosis at a more advanced stage.MethodsA cohort of 424 consecutive patients with histological diagnosis of GN were included in a retrospective data analysis. Kidney function was assessed by glomerular filtration rate (GFR) estimation at the time point of kidney biopsy and after consecutive immunosuppressive therapy. Censored events were death, initiation of dialysis or kidney transplantation, or progression of disease, defined as deterioration of CKD stage ≥1 from kidney biopsy to last available kidney function measurement.ResultsOccurrence of death, dialysis/transplantation or progression of disease were associated with GFR and CKD stage at the time of kidney biopsy (p < 0.001 for all). Patients with CKD stage 1 and 2 at kidney biopsy had fewer endpoints compared to patients with a GFR of <60 ml/min (p < 0.001).ConclusionKidney function at the time point of histological GN diagnosis is associated with clinical outcome, likely due to early initiation of specific drug treatment. This suggests that selection of therapy yields greatest benefit before renal function is impaired in GN.
Highlights
Interventional diagnostic procedures are established for several diseases in medicine
While current guidelines have established the medical management of glomerulonephritis (GN) including the necessity of histological analysis and administration of immunosuppressive therapies, it is yet unclear if early diagnosis may result in prevention of chronic kidney disease (CKD) development in this heterogeneous group of patients
Stage, is associated with different outcome compared to diagnosis of GN at a later CKD stage
Summary
Retrospective data from 917 consecutive patients who underwent kidney biopsy between 1992 and 2009 were identified. Among those 171 patients had diabetic nephropathy or secondary focal segmental glomerulosclerosis (FSGS) and were excluded. 424 patients with a histological diagnosis of GN who received immunosuppressive therapy were included into the analysis (Figure 1). Patients were characterized by CKD-stages according to their kidney function prior to biopsy and during follow up. Stable disease was regarded as constant or improved CKD stage from the time of kidney biopsy to last available kidney function measurement, without an episode of dialysis or kidney transplantation. After kidney biopsy patients received induction therapy with cortisone with or without cyclophosphamide as immunosuppressive therapy according to their histological diagnosis and adjusted to their body weight. The authors performing the data analysis (D.G.H. and V.F.) were masked and were not involved in the data acquisition
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