Clinical Correlation of Histopathological Classification, Scoring, and Grading in Amyloid Nephropathies: Single-Center Experience

Öz

Objective: Amyloidosis is disorder of various etiologies in which abnormally folded fibrillary protein deposits with more than thirty forms infiltrate into extracellular spaces of affected organs. Renal involvement is clinically characterized by decreased estimated glomerular filtration rate (eGFR) and proteinuria. The aim of present study was to classify and grade renal amyloidosis cases using renal amyloid prognostic score (RAPS) systems, correlate clinical data and chronic kidney disease (CKD) stages. Methods: We retrospectively analyzed kidney biopsies of 45 patients diagnosed with renal amyloidosis applied between 2017-2022 to our department and scored each of patients according to RAPS. Results: 8.9% of patients had RAPS score 1, 53.3% had 2 and 37.8% had 3. Urea, serum creatinine and proteinuria levels of RAPS3 patients were significantly higher and eGFR levels were lower compared to RAPS1 patients (p<0.01). According to CKD stages, no significant difference was observed in glomerular amyloid deposition class and score, vascular and interstitial amyloid deposition scores, and glomerular sclerosis (p>0.05). The interstitial fibrosis, inflammation values and RAPS scores were found to be significantly higher in advanced CKD stages (p<0.05). Majority of patients at CKD stage 1-2 had RAPS score 2 (73.68%), while 57.1% of at stage 3 and 66.7% at stage 4-5 had RAPS score of 3 (p=0.0015). Conclusion: As a result, the intestinal fibrosis, inflammation values, RAPS scores were significantly higher in advanced CKD stages. Distribution pattern of amyloid in the renal parenchyma compartment, grade of RAPS and eGFR were associated with urea/creatinine, proteinuria levels and thus with CKD stage.

Anahtar Kelimeler

• Grading
• amyloid nephropathy
• scoring
• classification.

Kaynakça

1. Sen S, Sarsik B. A proposed histopathologic classification, scoring, and grading system for renal amyloidosis: standardization of renal amyloid biopsy report. Arch Pathol Lab Med. 2010;134(4):532-44. doi:10.5858/134.4.532.
2. Owji SM, Raeisi Shahraki H, Owji SH. A 16-year Survey of Clinicopathological Findings, Electron Microscopy, and Classification of Renal Amyloidosis. Iran J Med Sci. 2021;46(1):32-42. doi:10.30476/ijms.2019.82110.
3. Qu Z, Zheng X, Wang SX, et al. Clinical and pathological features of renal amyloidosis: an analysis of 32 patients in a single Chinese centre. Nephrology. 2010;15(1):102-7. doi:10.1111/j.1440-1797.2009.01127.x.
4. Ozdemir A, Yılmaz M, Ozagari AA, Kocak SY. Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis. Int Urol Nephrol. 2022;54(10):2591-2597. doi:10.1007/s11255-022-03163-y.
5. Abe R, Katoh N, Takahashi Y, et al. Distribution of amyloidosis subtypes based on tissue biopsy site - Consecutive analysis of 729 patients at a single amyloidosis center in Japan. Pathol Int. 2021;71(1):70-79. doi:10.1111/pin.13041.
6. Rubinstein S, Cornell RF, Du L et al. Novel pathologic scoring tools predict end-stage kidney disease in light chain (AL) amyloidosis. Amyloid. 2017;24:205–211. doi:10.1080/13506129.2017.1360272.
7. Hoelbeek JJ, Kers J, Steenbergen EJ, Roelofs JJTH, Florquin S. Renal amyloidosis: validation of a proposed histological scoring system in an independent cohort. Clin Kidney J. 202024;14(3):855-862. doi:10.1093/ckj/sfaa019.
8. Gupta N, Kaur H, Wajid S. Renal amyloidosis: an update on diagnosis and pathogenesis. Protoplasma. 2020;257(5):1259-1276. doi:10.1007/s00709-020-01513-0.

9. Shlipak MG, Tummalapalli SL, Boulware LE, et al; Conference Participants. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99(1):34-47. doi:10.1016/j.kint.2020.10.012.
10. Levey AS, Gansevoort RT, Coresh J, et al. Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of CKD: A Scientific Workshop Sponsored by the National Kidney Foundation in Collaboration With the US Food and Drug Administration and European Medicines Agency. Am J Kidney Dis. 2020;75(1):84-104. doi:10.1053/j.ajkd.2019.06.009.
11. Evans M, Lewis RD, Morgan AR, et al. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv Ther. 2022;39(1):33-43. doi:10.1007/s12325-021-01927-z.
12. Alexander MP, Dasari S, Vrana JA, et al. Congophilic Fibrillary Glomerulonephritis: A Case Series. Am J Kidney Dis. 2018;72:325-36. doi:10.1053/j.ajkd.2018.03.017.
13. Tsai SF, Wen MC, Cheng CH, et al. Clinical features of renal amyloidosis: an analysis of 40 patients in a 28-year follow-up. Intern Med. 2011;50(21):2511-7. doi:10.2169/internalmedicine.50.5822.
14. Siddique N, Gillmore JD, Sattianayagam PT. Decreasing incidence of AA amyloidosis in Spain. Eur J Clin Invest. 2013;43(12):1372. doi:10.1111/eci.12157.
15. Bergesio F, Ciciani AM, Manganaro M, et al; Immunopathology Group of the Italian Society of Nephrology. Renal involvement in systemic amyloidosis: an Italian collaborative study on survival and renal outcome. Nephrol Dial Transplant. 2008;23(3):941-51. doi:10.1093/ndt/gfm684.
16. Ayar Y, Ersoy A, Yıldız A, et al. The evaluation of amyloidosis cases with renal involvement: A single-center experience. Turk Neph Dial Transpl. 2015;24(1):68-73. doi:10.5262/tndt.2015.1001.09.
17. Piskinpasa S, Dede F. Secondary Amyloidosis. Turkiye Klinikleri J Nephrol-Special Topics. 2013;6(3):45-9.
18. Lane T, Pinney JH, Gilbertson JA, et al. Changing epidemiology of AA amyloidosis: clinical observations over 25 years at a single national referral centre. Amyloid. 2017;24(3):162-166. doi:10.1080/13506129.2017.1342235.
19. Ansari N. Longest Survival with Renal AA Amyloidosis: Development of End Stage Renal Disease after 25 Years of AA Amyloidosis Diagnosis. J Urol Nephrol. 2016;3(1):5.
20. Erdogmus S, Kendi Celebi Z, Akturk S, et al. Profile of renal AA amyloidosis in older and younger individuals: a single-centre experience. Amyloid. 2018;25(2):115-119. doi:10.1080/13506129.2018.1474733.
21. Engineer DP, Kute VB, Patel HV, Shah PR. Clinical and laboratory profile of renal amyloidosis: A single-center experience. Saudi J Kidney Dis Transpl. 2018;29:1065-72. doi:10.4103/1319-2442.243966.
22. Kalle A, Gudipati A, Raju SB, et al. Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience. J Lab Physicians. 2018;10(2):226-231. doi:10.4103/JLP.JLP_148_17.
23. Said SM, Sethi S, Valeri AM, et al. Renal amyloidosis: origin and clinicopathologic correlations of 474 recent cases. Clin J Am Soc Nephrol. 2013;8:1515-23. doi:10.2215/CJN.10491012.