Frontiers in endocrinology · 2026
Prognostic significance of interstitial fibrosis and tubular atrophy in biopsy-proven diabetic kidney disease: a single-center retrospective cohort study.
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Zhang Rui, Wu Mingyan, Yang Hui, Zhou Xingyan, Guo Ziwei, Yu Haiyan, Song Wenyu, Bao Yi, Yang Yuxing, Yan Rui
Аннотация
BACKGROUND: Interstitial fibrosis and tubular atrophy (IFTA) is an important pathological feature of diabetic kidney disease (DKD). Its prognostic value in biopsy-proven DKD remains incompletely understood.
METHODS: In this retrospective study, 164 patients with type 2 diabetes and biopsy-confirmed pure DKD were followed for a median of 38 months. The primary composite kidney endpoint was initiation of kidney replacement therapy or kidney-related death. Predictors were selected using LASSO Cox regression. Random survival forest was used as an exploratory complementary analysis.
RESULTS: Thirty-four patients reached the composite kidney endpoint. After LASSO selection and multivariable adjustment, IFTA score 2/3 (vs. IFTA score 1, HR 3.96, 95%, CI 1.71-9.16, P = 0.001), 24-hour proteinuria (per 1 g/day increase; HR 1.52, 95%, CI 1.19-1.94, P < 0.001), and lower serum calcium (per 1 mmol/L increase; HR 0.140, 95% CI 0.041-0.481, P = 0.002) were independently associated with the composite kidney endpoint. In the random survival forest analysis, serum calcium, baseline eGFR, and IFTA were among the most important variables. Patients with IFTA 2/3 had significantly lower kidney survival than those with IFTA 1 (log-rank P = 0.0056).
CONCLUSIONS: In biopsy-proven DKD, IFTA 2/3 was associated with the composite kidney endpoint. Higher 24-hour proteinuria and lower serum calcium were associated with poor kidney outcomes. Further studies are needed to confirm these findings and clarify their clinical implications.
METHODS: In this retrospective study, 164 patients with type 2 diabetes and biopsy-confirmed pure DKD were followed for a median of 38 months. The primary composite kidney endpoint was initiation of kidney replacement therapy or kidney-related death. Predictors were selected using LASSO Cox regression. Random survival forest was used as an exploratory complementary analysis.
RESULTS: Thirty-four patients reached the composite kidney endpoint. After LASSO selection and multivariable adjustment, IFTA score 2/3 (vs. IFTA score 1, HR 3.96, 95%, CI 1.71-9.16, P = 0.001), 24-hour proteinuria (per 1 g/day increase; HR 1.52, 95%, CI 1.19-1.94, P < 0.001), and lower serum calcium (per 1 mmol/L increase; HR 0.140, 95% CI 0.041-0.481, P = 0.002) were independently associated with the composite kidney endpoint. In the random survival forest analysis, serum calcium, baseline eGFR, and IFTA were among the most important variables. Patients with IFTA 2/3 had significantly lower kidney survival than those with IFTA 1 (log-rank P = 0.0056).
CONCLUSIONS: In biopsy-proven DKD, IFTA 2/3 was associated with the composite kidney endpoint. Higher 24-hour proteinuria and lower serum calcium were associated with poor kidney outcomes. Further studies are needed to confirm these findings and clarify their clinical implications.