Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years

doi:10.1007/s10157-025-02706-8

. 2025 May 28.

doi: 10.1007/s10157-025-02706-8. Online ahead of print.

Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years

Yoichi Oshima^{1

2

3}, Naoki Sawa^{4

5}, Masayuki Yamanouchi^{4

5}, Akinari Sekine^{4

5}, Hiroki Mizuno^{4

5}, Daisuke Ikuma^{4

5}, Yuki Oba^{4

5}, Noriko Inoue⁴, Kiho Tanaka⁴, Eiko Hasegawa⁴, Tatsuya Suwabe^{4

5}, Kei Kono⁶, Keiichi Kinowaki⁶, Kenichi Ohashi^{6

7}, Yutaka Yamaguchi⁸, Junichi Hoshino^{4

9}, Yoshifumi Ubara^{4

5}

Affiliations

¹ Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan. yoichi-o-s@hotmail.co.jp.
² Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo, Japan. yoichi-o-s@hotmail.co.jp.
³ Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan. yoichi-o-s@hotmail.co.jp.
⁴ Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
⁵ Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan.
⁶ Department of Pathology, Toranomon Hospital, Tokyo, Japan.
⁷ Department of Human Pathology, Institute of Science Tokyo, Tokyo, Japan.
⁸ Yamaguchi's Pathology Laboratory, Chiba, Japan.
⁹ Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.

PMID: 40434507
DOI: 10.1007/s10157-025-02706-8

Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years

Yoichi Oshima et al. Clin Exp Nephrol. 2025.

. 2025 May 28.

doi: 10.1007/s10157-025-02706-8. Online ahead of print.

Authors

Affiliations

¹ Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan. yoichi-o-s@hotmail.co.jp.
² Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo, Japan. yoichi-o-s@hotmail.co.jp.
³ Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan. yoichi-o-s@hotmail.co.jp.
⁴ Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
⁵ Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Kawasaki, Kanagawa, 213-8587, Japan.
⁶ Department of Pathology, Toranomon Hospital, Tokyo, Japan.
⁷ Department of Human Pathology, Institute of Science Tokyo, Tokyo, Japan.
⁸ Yamaguchi's Pathology Laboratory, Chiba, Japan.
⁹ Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.

PMID: 40434507
DOI: 10.1007/s10157-025-02706-8

Abstract

Background: Numerous kidney diseases progress to end-stage kidney disease (ESKD); however, a limited number of cohort studies have evaluated the underlying kidney diseases through kidney biopsy (KB).

Methods: We retrospectively evaluated all patients who initiated dialysis at Toranomon Hospital, Japan, from 1985 to 2019, and whose underlying kidney disease had been diagnosed by KB. The data on histopathological diagnosis and various clinical characteristics were collected and analyzed for 357 patients.

Results: The most prevalent underlying diseases, which constituted the primary endpoint of this study, were diabetic nephropathy (DN; n = 100, 28.0%), IgA nephropathy (IgAN; n = 99, 27.7%), and focal segmental glomerulosclerosis (n = 34, 9.5%). Benign nephrosclerosis (BNS; n = 1, 0.3%), that is, arteriosclerosis/arteriolosclerosis without distinct glomerulopathy, was rare. As the secondary endpoint, Cox regression analysis revealed that lower eGFR (p < 0.0001), higher proteinuria (p < 0.0001), older age (p = 0.005) and presence of DN (p = 0.008) were significant independent risk factors for early dialysis initiation. In the subgroup analysis, when comparing DN and IgAN, significantly earlier dialysis initiation was observed in DN than in IgAN by log-rank analysis (p < 0.0001), as well as after adjustment for baseline clinical characteristics using propensity score matching (n = 45 each) (p = 0.023).

Conclusions: We identified a list of kidney diseases that were at risk for ESKD at the time of KB through a long-term follow-up. DN and IgAN are the two primary causes of ESKD, whereas BNS is an infrequent direct cause of ESKD in patients requiring kidney biopsy.

Keywords: Benign nephrosclerosis; Diabetic nephropathy; End stage kidney disease; IgA nephropathy; Kidney biopsy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing financial interests related to this work.

References

1. Nitta K, Goto S, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, et al. Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data, incidence, prevalence, and mortality. Renal Replacement Therapy. 2020;6(1):41. https://doi.org/10.1186/s41100-020-00286-9 . - DOI
1. Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. ’United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59(1):e1-420. https://doi.org/10.1053/j.ajkd.2011.11.015 . - DOI
1. Navaratnarajah A, Sambasivan K, Cook TH, Pusey C, Roufosse C, Willicombe M. Predicting long-term renal and patient survival by clinicopathological features in elderly patients undergoing a renal biopsy in a UK cohort. Clin Kidney J. 2019;12(4):512–20. https://doi.org/10.1093/ckj/sfz006 . - DOI - PubMed - PMC
1. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92. https://doi.org/10.1053/j.ajkd.2008.12.034 . - DOI - PubMed
1. Hiramatsu R, Hoshino J, Suwabe T, Sumida K, Hasegawa E, Yamanouchi M, et al. Membranoproliferative glomerulonephritis and circulating cryoglobulins. Clin Exp Nephrol. 2014;18(1):88–94. https://doi.org/10.1007/s10157-013-0810-z . - DOI - PubMed

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[1] Nitta K, Goto S, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, et al. Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data, incidence, prevalence, and mortality. Renal Replacement Therapy. 2020;6(1):41. https://doi.org/10.1186/s41100-020-00286-9 . - DOI

[2] Nitta K, Goto S, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, et al. Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data, incidence, prevalence, and mortality. Renal Replacement Therapy. 2020;6(1):41. https://doi.org/10.1186/s41100-020-00286-9 . - DOI

[3] Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. ’United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59(1):e1-420. https://doi.org/10.1053/j.ajkd.2011.11.015 . - DOI

[4] Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. ’United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59(1):e1-420. https://doi.org/10.1053/j.ajkd.2011.11.015 . - DOI

[5] Navaratnarajah A, Sambasivan K, Cook TH, Pusey C, Roufosse C, Willicombe M. Predicting long-term renal and patient survival by clinicopathological features in elderly patients undergoing a renal biopsy in a UK cohort. Clin Kidney J. 2019;12(4):512–20. https://doi.org/10.1093/ckj/sfz006 . - DOI - PubMed - PMC

[6] Navaratnarajah A, Sambasivan K, Cook TH, Pusey C, Roufosse C, Willicombe M. Predicting long-term renal and patient survival by clinicopathological features in elderly patients undergoing a renal biopsy in a UK cohort. Clin Kidney J. 2019;12(4):512–20. https://doi.org/10.1093/ckj/sfz006 . - DOI - PubMed - PMC

[7] Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92. https://doi.org/10.1053/j.ajkd.2008.12.034 . - DOI - PubMed

[8] Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92. https://doi.org/10.1053/j.ajkd.2008.12.034 . - DOI - PubMed

[9] Hiramatsu R, Hoshino J, Suwabe T, Sumida K, Hasegawa E, Yamanouchi M, et al. Membranoproliferative glomerulonephritis and circulating cryoglobulins. Clin Exp Nephrol. 2014;18(1):88–94. https://doi.org/10.1007/s10157-013-0810-z . - DOI - PubMed

[10] Hiramatsu R, Hoshino J, Suwabe T, Sumida K, Hasegawa E, Yamanouchi M, et al. Membranoproliferative glomerulonephritis and circulating cryoglobulins. Clin Exp Nephrol. 2014;18(1):88–94. https://doi.org/10.1007/s10157-013-0810-z . - DOI - PubMed

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Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years

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Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years

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