{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:46:28Z","timestamp":1793357188655,"version":"4.5.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"DOI":"10.13039\/100000062","name":"National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01 DK090358"],"award-info":[{"award-number":["R01 DK090358"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>A higher percentage of the kidney cortex area that exhibits interstitial fibrosis\/tubular atrophy (IF\/TA) is a feature of poor prognosis on biopsy. This study describes IF\/TA density (the number of IF\/TA foci per area of cortex) and shows it predicts progressive CKD, independent of both percentage IF\/TA and clinical characteristics among patients who have undergone nephrectomy. Other patterns of IF\/TA and inflammation were not predictive for progressive CKD and mortality beyond percentage IF\/TA and clinical characteristics. At the same percentage IF\/TA, a higher IF\/TA density suggests more scattered and widespread damage to the nephrons, with a worse kidney prognosis. This information may be helpful for accurate interpretation of the severity of \u201cchronic changes\u201d observed on a kidney biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic tubulointerstitial injury on kidney biopsy is usually quantified by the percentage of cortex with interstitial fibrosis\/tubular atrophy (IF\/TA). Whether other patterns of IF\/TA or inflammation in the tubulointerstitium have prognostic importance beyond percentage IF\/TA is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We obtained, stained, and digitally scanned full cortical thickness wedge sections of renal parenchyma from patients who underwent a radical nephrectomy for a tumor over 2000\u20132015, and morphometrically analyzed the tubulointerstitium of the cortex for percentage IF\/TA, IF\/TA density (foci per mm\n                      <jats:sup>2<\/jats:sup>\n                      cortex), percentage subcapsular IF\/TA, striped IF\/TA, percentage inflammation (both within and outside IF\/TA regions), and percentage subcapsular inflammation. Patients were followed with visits every 6\u201312 months. Progressive CKD was defined as dialysis, kidney transplantation, or 40% decline from the postnephrectomy eGFR. Cox models assessed the risk of CKD or noncancer mortality with morphometric measures of tubulointerstitial injury after adjustment for the percentage IF\/TA and clinical characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 936 patients (mean age, 64 years; postnephrectomy baseline eGFR, 48 ml\/min per 1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ), 117 progressive CKD events and 183 noncancer deaths occurred over a median 6.4 years. Higher IF\/TA density predicted both progressive CKD and noncancer mortality after adjustment for percentage IF\/TA and predicted progressive CKD after further adjustment for clinical characteristics. Independent of percentage IF\/TA, age, and sex, higher IF\/TA density correlated with lower eGFR, smaller nonsclerosed glomeruli, more global glomerulosclerosis, and smaller total cortical volume.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher density of IF\/TA foci (a more scattered pattern with more and smaller foci) predicts higher risk of progressive CKD after radical nephrectomy compared with the same percentage of IF\/TA but with fewer and larger foci.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2021020267","type":"journal-article","created":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T15:35:15Z","timestamp":1624030515000},"page":"2623-2633","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":37,"title":["A Higher Foci Density of Interstitial Fibrosis and Tubular Atrophy Predicts Progressive CKD after a Radical Nephrectomy for Tumor"],"prefix":"10.1681","volume":"32","author":[{"given":"Luisa","family":"Ricaurte Archila","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Denic","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidan F.","family":"Mullan","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3310-1364","authenticated-orcid":false,"given":"Ramya","family":"Narasimhan","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Bogojevic","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Houston","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Urology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley C.","family":"Leibovich","sequence":"additional","affiliation":[{"name":"Department of Urology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Jeson","family":"Sangaralingham","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam P.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0338-7784","authenticated-orcid":false,"given":"Andrew D.","family":"Rule","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota"},{"name":"Division of Epidemiology, Mayo Clinic, Rochester, 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