• Deceased-Donor Kidney Biopsy Scoring Systems for Predicting Future Graft Function: A Comparative Study

      Chen, K.; Guntur, G.; Stalam, T.; Okonkwo, N.; Drachenberg, C.; Goussous, N.; Bruno, D.; Mas, V.; Bromberg, J.; Haririan, A. (Elsevier Inc., 2020-12-24)
      Background: Deceased-donor kidney quality pretransplantation is considered critical for future graft function. Assessment of donor kidney quality considers clinical and histologic variables. Several models that incorporate a variety of these factors have been proposed to predict long-term graft survival. Methods: We compared the performance metrics of 4 scoring systems models---the Maryland Aggregate Pathology Index, Banff, Remuzzi, and Leuven---for predicting renal allograft survival. In this retrospective cohort study, we analyzed 173 renal allografts that underwent preoperative baseline biopsy. Donor demographics and donor baseline histopathology data were collected and correlated with graft survival posttransplant. Results: Among the 4 scoring systems, none were significantly associated with posttransplant graft survival or early graft function. The Maryland Aggregate Pathology Index scoring system had better predictive capacity in receiver operating characteristic curve analysis; however, the utility as a predictor of graft survival was only slightly better than chance. Baseline histologic features were individually analyzed, and it was found that none were associated with graft survival in this cohort. Among donor demographics, none were significantly associated with graft survival. Conclusions: In our study none of the 4 previously proposed predictive models were associated with graft survival after transplantation. Further studies are needed to define new models with stronger predictive value for graft outcome that could help minimize organ discards. Copyright 2020 The Authors
    • Epidemiology and Pathophysiology of Glomerular C4d Staining in Native Kidney Biopsies

      Drachenberg, C.B.; Papadimitriou, J.C.; Chandra, P.; Haririan, A.; Mendley, S.; Weir, M.R; Rubin, M.F. (Elsevier Inc, 2019)
      Introduction: Routine C4d staining in renal transplantation has stimulated its use in kidney biopsies with glomerulonephritis (GN). Methodical description on staining patterns in the native kidney is not available. Methods: We retrospectively evaluated C4d staining in formalin-fixed paraffin-embedded sections from 519 native kidney biopsies (bx) with and without glomerular disease. Results: Strong C4d staining was consistently present in immune-complex GN, including lupus nephritis (LN) (n = 68), membranous GN (n = 24), membranoproliferative glomerulonephritis (MPGN) pattern (n = 22), fibrillary GN (n = 3), and proliferative GN with monoclonal IgG (n = 3). C4d stained all cases of postinfectious GN (n = 7) amyloidosis (n = 20) and C1q GN (n = 3). In contrast, IgA nephropathy (IgAN) (n = 34), was negative in 62% of bx, with the rest staining variably. The E1 Oxford classification score correlated with capillary wall C4d staining (P = 0.05). C4d marked the glomerular and arteriolar lesions in thrombotic microangiopathy (TMA; n = 16), the glomerular sclerotic segments in focal segmental glomerulosclerosis (FSGS; n = 77), and marked areas of necrosis in crescentic GN (n = 21). In diabetic glomerulopathy (n = 70), C4d marked advanced insudative lesions but was negative otherwise. C4d weakly stained the mesangium, or was negative in normal biopsies (n = 13), minimal change disease (MCD; n = 21), thin basement membrane disease (n = 20), Alport (n = 3), IgM nephropathy (n = 2), C3 glomerulopathy (n = 5), acute interstitial nephritis (n = 12), acute tubular necrosis (n = 22), ischemic glomerulopathy/nephrosclerosis (n = 23), and other miscellaneous processes (n = 14). Staining in tubular basement membranes and peritubular capillaries was most common in lupus. Conclusion: Based on reliable staining in lupus and membranous GN, C4d staining is potentially useful as a screening and diagnostic tool, if only paraffin-embedded tissue is available. Knowledge of C4d staining patterns in normal and pathological tissues enhances its diagnostic value.
    • Tubular Epithelial and Peritubular Capillary Endothelial Injury in COVID-19 AKI

      Papadimitriou, J.C.; Drachenberg, C.B.; Kleiner, D.; Choudhri, N.; Haririan, A.; Cebotaru, V. (Elsevier Inc., 2020-11-05)