scholarly journals Conventional Type 1 Dendritic Cells (cDC1) in Human Kidney Diseases: Clinico-Pathological Correlations

2021 ◽  
Vol 12 ◽  
Author(s):  
Titi Chen ◽  
Qi Cao ◽  
Ruifeng Wang ◽  
Guoping Zheng ◽  
Farhana Azmi ◽  
...  
Keyword(s):  
T Cells ◽  
Lupus Nephritis ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Kidney Diseases ◽  
Human Kidney ◽  
Acute Interstitial Nephritis ◽  
Cell Number ◽  
Pathological Features ◽  
Cross Presentation

BackgroundcDC1 is a subset of conventional DCs, whose most recognized function is cross-presentation to CD8+ T cells. We conducted this study to investigate the number and location of cDC1s in various human kidney diseases as well as their correlation with clinico-pathological features and CD8+ T cells.MethodsWe analyzed 135 kidney biopsies samples. Kidney diseases included: acute tubular necrosis (ATN), acute interstitial nephritis (AIN), proliferative glomerulonephritis (GN) (IgA nephropathy, lupus nephritis, pauci-immune GN, anti-GBM disease), non-proliferative GN (minimal change disease, membranous nephropathy) and diabetic nephropathy. Indirect immunofluorescence staining was used to quantify cDC1s, CD1c+ DCs, and CD8+ T cells.ResultscDC1s were rarely present in normal kidneys. Their number increased significantly in ATN and proliferative GN, proportionally much more than CD1c+ DCs. cDC1s were mainly found in the interstitium, except in lupus nephritis, pauci-immune GN and anti-GBM disease, where they were prominent in glomeruli and peri-glomerular regions. The number of cDC1s correlated with disease severity in ATN, number of crescents in pauci-immune GN, interstitial fibrosis in IgA nephropathy and lupus nephritis, as well as prognosis in IgA nephropathy. The number of CD8+ T cells also increased significantly in these conditions and cDC1 number correlated with CD8+ T cell number in lupus nephritis and pauci-immune GN, with many of them closely co-localized.ConclusionscDC1 number correlated with various clinic-pathological features and prognosis reflecting a possible role in these conditions. Their association with CD8+ T cells suggests a combined mechanism in keeping with the results in animal models.

scholarly journals Immune cell composition in normal human kidneys

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun-Gyu Park ◽  
Myeongsu Na ◽  
Min-Gang Kim ◽  
Su Hwan Park ◽  
Hack June Lee ◽  
...  
Keyword(s):  
T Cells ◽  
Immune Cells ◽  
Immune Cell ◽  
Kidney Diseases ◽  
Myeloid Cells ◽  
Human Kidney ◽  
Effector Memory ◽  
Immune Cell Subsets ◽  
Immunological Mechanisms ◽  
Normal Human

Abstract An understanding of immunological mechanisms in kidney diseases has advanced using mouse kidneys. However, the profiling of immune cell subsets in human kidneys remains undetermined, particularly compared with mouse kidneys. Normal human kidneys were obtained from radically nephrectomised patients with urogenital malignancy (n = 15). Subsequently, human kidney immune cell subsets were analysed using multicolor flow cytometry and compared with subsets from C57BL/6 or BALB/c mice under specific pathogen-free conditions. Twenty kidney sections from healthy kidney donors or subjects without specific renal lesions were additionally analysed by immunohistochemistry. In human kidneys, 47% ± 12% (maximum 63%) of immune cells were CD3+ T cells. Kidney CD4+ and CD8+ T cells comprised 44% and 56% of total T cells. Of these, 47% ± 15% of T cells displayed an effector memory phenotype (CCR7− CD45RA− CD69−), and 48% ± 19% were kidney-resident cells (CCR7− CD45RA− CD69+). However, the proportions of human CD14+ and CD16+ myeloid cells were approximately 10% of total immune cells. A predominance of CD3+ T cells and a low proportion of CD14+ or CD68+ myeloid cells were also identified in healthy human kidney sections. In mouse kidneys, kidney-resident macrophages (CD11blow F4/80high) were the most predominant subset (up to 50%) but the proportion of CD3+ T cells was less than 20%. These results will be of use in studies in which mouse results are translated into human cases under homeostatic conditions or with disease.

P0136COMPARISON OF SECONDARY IGA NEPHROPATHY OF ANKYLOSING SPONDYLITIS AND PRIMARY IGA NEPHROPATHY IN CLINICAL AND PATHOLOGICAL FEATURES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Qin Xue ◽  
Guang Li Zhang ◽  
Zebo Tian
Keyword(s):  
Retrospective Study ◽  
Ankylosing Spondylitis ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Renal Involvement ◽  
Control Group ◽  
Pathological Features ◽  
Tubular Atrophy ◽  
The Difference ◽  
Clinical And Pathological Features

Abstract Background and Aims Renal involvement is one of the most common extra-articular complications caused by ankylosing spondylitis (AS). The main pathological manifestation is secondary IgA nephropathy(SIgAN) in Chinese AS patients. The difference between SIgAN and primary IgAN (PIgAN) remains unclear due to the lack of cases. Therefore, the aim of this retrospective study was to compare the clinical and pathological features of SIgAN of AS (SIgAN-AS) and PIgAN, to detect the pathogenesis of SIgAN Method Clinical characteristics and pathological data were collected in patients who were diagnosed with IgAN by renal biopsy in our hospital from Jan 2008 to Oct 2018. Patients with SIgAN-AS were recruited by the ratio 1:5 of patients with primary IgAN as the control group in the study. Fifteen patients with SIgAN-AS and Seventy-five patients with PIgAN were enrolled in this retrospective study. Results There were 15 cases in AS group, including 13 male and 2 female. The cohort of 75 patients with PIgAN included 34 male and 41 female. There were more males in AS group 13/15 (86.7%) vs 37/75(49.3%) ,P < 0.05. Compared with PIgAN patients, SIgAN-AS patients had higher incidences of hematuria( 13/15(86.7%)vs 44/75 (58.7%) , P < 0.05), lower levels of 24-hour urinary protein(0.85±0.68 vs 1.57±1.54g, P < 0.05), but higher levels of eGFR (CKD-MDRD formula) (117.60±37.33 vs 85.35±31.36, P < 0.05),eGFR (CKD-EPI formula) (128.01±41.58 vs 92.75±36.09, P < 0.05), Albumin (44.67±3.48 vs 41.09±7.07 g/L, P < 0.05) ESR (43.20 ±33.94 vs 18.79±16.26mm/h, P < 0.001) , and CRP (21.19±30.61 vs 2.11±4.58mg/L, P < 0.001) . From the perspective of renal pathology of PIgAN, SIgA-AS patients had fewer incidences of renal tubular atrophy / interstitial fibrosis of nephropathy (P <0.05). The immunohistostaining analysis showed higher incidences of dominant deposits of single IgA in mesangial cell area (P < 0.05). Conclusion Patients with SIgAN-AS is more common in male and display a milder progression than those with primary IgAN. Majority of the SIgAN-AS can be improved with early intervention.

scholarly journals Involvement of IL-4 in human glomerulonephritis: an in situ hybridization study of IL-4 mRNA and IL-4 receptor mRNA.

1997 ◽  
Vol 8 (5) ◽  
pp. 730-741
Author(s):  
A Furusu ◽  
M Miyazaki ◽  
T Koji ◽  
K Abe ◽  
Y Ozono ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
Lupus Nephritis ◽  
Iga Nephropathy ◽  
Mesangial Cells ◽  
Human Kidney ◽  
Proliferative Glomerulonephritis ◽  
Mesangial Proliferative Glomerulonephritis ◽  
Glomerular Injury ◽  
Bowman's Capsule

Interleukin-4 (IL-4) has been recently implicated in the pathogenesis of glomerulonephritis. However, the expression of IL-4 and IL-4 receptor (IL-4R) in human kidney has not been fully determined. Nonradioactive in situ hybridization was used to examine the expression of IL-4 mRNA and IL-4R mRNA in tissues from normal kidneys and specimens from a variety of human kidney diseases. In normal glomeruli, a few mesangial cells and cells of the Bowman's capsule weakly expressed IL-4 and IL-4R mRNA, whereas in diseased glomeruli both mRNA types were strongly expressed in resident glomerular cells, including mesangial cells, glomerular epithelial cells, and cells of the Bowman's capsule. The relationship between the expression of these mRNA and the degree of glomerular injury was different in different types of glomerulonephritis. In IgA nephropathy and non-IgA mesangial proliferative glomerulonephritis, IL-4 expression correlated positively with the degree of mesangial hypercellularity and extracellular matrix expansion. However, IL-4R expression was relatively constant. In contrast, the expression of IL-4 and IL-4R mRNA correlated negatively with the degree of glomerular injury in lupus nephritis. Coexpression and discordant expression of these mRNA forms were observed in individual cells. In tubulointerstitium with severe lesions, IL-4 mRNA and IL-4R mRNA were observed in atrophic tubules and some of the infiltrating cells and fibroblasts. The interstitial expression of these mRNA forms was similar in IgA nephropathy, non-IGA mesangial proliferative glomerulonephritis, and lupus nephritis and correlated positively with the degree of tubulo-interstitial changes. These results suggest that an autocrine and/or paracrine pathway of IL-4 is present in human diseased kidneys and that IL-4 may be involved in tissue injury in glomerulonephritis.

scholarly journals Assessment of seven year long results of kidney biopsy

2019 ◽  
Vol 6 (3) ◽  
pp. 822
Author(s):  
Nambakam Tanuja Subramanyam ◽  
Girish P. Vakrani
Keyword(s):  
Nephrotic Syndrome ◽  
Lupus Nephritis ◽  
Iga Nephropathy ◽  
Kidney Biopsy ◽  
Kidney Diseases ◽  
Diagnostic Yield ◽  
Pediatric Population ◽  
Histopathological Diagnosis ◽  
Tissue Analysis ◽  
Needle Size

Background: Kidney biopsy is a standard kidney biopsy tissue analysis to look at histopathological diagnosis of various kidney diseases. Previous studies have shown kidney biopsy findings mostly in pediatric population, and there is no much data on impact of various sized biopsy guns on biopsy outcome. This study includes all age group and describes impact of usage of various sized biopsy guns on biopsy outcome.Methods: A retrospective study was done on all patients who underwent kidney biopsy over 7 years.Results: Among total number of 386 patients, 55.2% were males. The commonest indication for biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Renal failure (RF) was found in 157 (40.7%) of which it improved in 78 (20.2%). Amongst RF patients, the commonest was IgA nephropathy. Change of needle size from 18G to 16G showed increased morbidity in the form of complications but also increased diagnostic yield. Biopsy related complications were noted in 0.8%-1.8%.Conclusions: The commonest indication for kidney biopsy was nephrotic syndrome. The commonest histopathological pattern was Lupus nephritis. Amongst RF patients, the commonest entity was IgA nephropathy. Change of needle size from thinner to thicker showed increased complications but also increased diagnostic yield too.

T cells and tryptase mast cells increase interstitial fibrosis of IgA nephropathy as a subsequence of severe glomerulitis

Nephrology ◽  
2000 ◽  
Vol 5 (s1) ◽  
pp. A16-A16
Author(s):  
Y Sasatomi ◽  
S Hisano ◽  
Y Kiyoshi ◽  
M Tada ◽  
N Uesugi ◽  
...  
Keyword(s):  
T Cells ◽  
Mast Cells ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis

scholarly journals Immunophenotypical Characterization of M1/M2 Macrophages and Lymphocytes in Cisplatin-Induced Rat Progressive Renal Fibrosis

Cells ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 257
Author(s):  
Minto Nakagawa ◽  
Mohammad Rabiul Karim ◽  
Takeshi Izawa ◽  
Mitsuru Kuwamura ◽  
Jyoji Yamate
Keyword(s):  
T Cells ◽  
Late Stage ◽  
Renal Fibrosis ◽  
Interstitial Fibrosis ◽  
Kidney Diseases ◽  
Tubular Damage ◽  
M2 Macrophages ◽  
Renal Interstitial Fibrosis ◽  
M1 Macrophages ◽  
Renal Lesions

Renal fibrosis is regarded as the common final pathway leading to chronic kidney diseases; macrophages and myofibroblasts play important roles in the development of fibrosis. F344 rats were injected once with cisplatin (CDDP; 6 mg/kg BW) for renal lesions. Here, immunophenotypical characteristics of macrophages and lymphocytes in CDDP-induced rat renal lesions were investigated histopathologically; the CDDP-induced renal lesions consisted of tissue damage at the early-stage, worsen the damage and commencement of interstitial fibrosis at the mid-stage, and progressive fibrosis at the late stage; the KIM-1 expression and α-SMA+ myofibroblast area reflected renal tubular damage/abnormal regeneration and renal interstitial fibrosis, respectively. CD68+ M1 macrophages began to increase at the mid-stage, with increased mRNA expressions of M1-related cytokines (INF-γ, TNF-α and IL-6), and then slightly decreased at the late-stage. CD163+ M2 macrophages showed a gradually increased number at the mid- and late-stages, accompanied by increased TGF-β1 mRNA expression (a fibrogenic factor). Double immunofluorescence using fibrotic samples at the late-stage revealed that 62.0–78.0% of CD68+ M1 macrophages co-expressed CD163, indicating that M1/M2 macrophages may contribute to progressive renal fibrosis in cooperation; further, MHC class II-expressing macrophages had a tendency towards M1 polarization, whereas CD204-expressing macrophages towards M2 polarization. In addition, CD4+ and CD8+ T cells were increased at the late-stage. Collectively, progressive renal interstitial fibrosis may be developed by complicated mechanisms that arose via interaction of M1/M2 macrophages (inflammatory for M1 and anti-inflammatory for M2) and T cells reacting to CD4 (for helper) and CD8 (for cytotoxicity). This study would provide some information on the pathogenesis of renal fibrosis based on inflammatory cells.

scholarly journals Urinary sediments could differentiate the endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephrology

2020 ◽  
Author(s):  
Mo Yuan ◽  
Jing-zi Li ◽  
Xiao-juan Yu ◽  
Hong Zhang ◽  
Ying Tan
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Proliferative Glomerulonephritis ◽  
Renal Outcome ◽  
Pathological Features ◽  
Urinary Sediment ◽  
Proliferative Lupus Nephritis ◽  
Endocapillary Proliferative Glomerulonephritis

Abstract Background: The role of manual urine sediment examination in the diagnosis and prognostication of endocapillary proliferative glomerulonephritis remains to be elucidated. This study aims to investigated the differences of urinary sediment findings between lupus nephritis and IgA nephropathy with endocapillary proliferative glomerulonephritis and further evaluated associations of leukocyturia with disease activity, pathological features and prognosis.Methods: The urinary sediment of 126 patients, including 92 patients with lupus nephritis and 34 patients with IgA nephropathy, with a renal biopsy-proven endocapillary proliferative glomerulonephritis were examined in the morning before renal biopsy according to a standardized method. The urinary elements investigated including various cells, casts and crystals. The associations of the level of leukocyturia and disease activity, pathological features and prognosis were further analyzed.Results: In the patients with endocapillary proliferative glomerulonephritis, normal to mild leukocyturia (≤12/HPF), and moderate to severe leukocyturia (>12/HPF) were found in 52(41.27%) and 74 (58.73%) patients, respectively. The proportion of moderate to severe leukocyturia, the frequency of urinary white blood cells casts and waxy casts were significantly higher in endocapillary proliferative lupus nephritis patients compared with endocapillary proliferative IgA nephropathy patients (P<0.001, P=0.020, P=0.010, respectively). In the proliferative lupus nephritis group, the levels of leukocyturia was significantly correlated with serum creatinine (r=0.288, P=0.005), eGFR (r=-0.284, P= 0.006), serum C3 (r=-0.275, P= 0.009) , SLEDAI scores (r=0.383, P=＜0.001) and glomerular leukocyte infiltration (r=0.285, P= 0.002). A multivariate analysis showed that leukocyturia was identified as an independent risk factor for renal outcome in proliferative lupus nephritis (HR: 1.456, 95% CI: 1.083-1.957, P=0.013) but not in IgA nephropathy (HR: 1.069, 95% CI: 0.494-2.312, P=0.866).Conclusions: Urinary sediments of the endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephrology differed in many aspects. Leukocyturia could reflect the disease activity and prognosis of endocapillary proliferative glomerulonephritis, especially in lupus nephritis.

scholarly journals Creation of X-linked Alport syndrome rat model with Col4a5 deficiency

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Masumi Namba ◽  
Tomoe Kobayashi ◽  
Mayumi Kohno ◽  
Takayuki Koyano ◽  
Takuo Hirose ◽  
...  
Keyword(s):  
Rat Model ◽  
Alport Syndrome ◽  
Interstitial Fibrosis ◽  
Kidney Diseases ◽  
Human Kidney ◽  
Pharmacological Therapy ◽  
Renal Diseases ◽  
Cell Hyperplasia ◽  
Type Iv ◽  
Mutant Rat

AbstractAlport syndrome is an inherited chronic human kidney disease, characterized by glomerular basement membrane abnormalities. This disease is caused by mutations in COL4A3, COL4A4, or COL4A5 gene. The knockout mice for Col4α3, Col4α4, and Col4α5 are developed and well characterized for the study of Alport syndrome. However, disease progression and effects of pharmacological therapy depend on the genetic variability. This model was reliable only to mouse. In this study, we created a novel Alport syndrome rat model utilizing the rGONAD technology, which generated rat with a deletion of the Col4α5 gene. Col4α5 deficient rats showed hematuria, proteinuria, high levels of BUN, Cre, and then died at 18 to 28 weeks of age (Hemizygous mutant males). Histological and ultrastructural analyses displayed the abnormalities including parietal cell hyperplasia, mesangial sclerosis, and interstitial fibrosis. Then, we demonstrated that α3/α4/α5 (IV) and α5/α5/α6 (IV) chains of type IV collagen disrupted in Col4α5 deficient rats. Thus, Col4α5 mutant rat is a reliable candidate for the Alport syndrome model for underlying the mechanism of kidney diseases and further identifying potential therapeutic targets for human renal diseases.

P0440EPIDEMIOLOGICAL AND CLINICAL CHARACTERSTICS OF IGA NEPHROPATHY PATIENTS IN TURKEY: TSN-GOLD WORKING GROUP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Necmi Eren ◽  
Meltem Gursu ◽  
Egemen Cebeci ◽  
Aydin Turkmen ◽  
Hasan Haci Yeter ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Clinical Data ◽  
Working Group ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Pathological Features ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Glomerular Diseases ◽  
Lower Egfr

Abstract Background and Aims According to the data of the Turkish Society of Nephrology-Glomerular Diseases Working Group (TSN-GOLD Working Group), IgA nephropathy is the most common primary glomerular disease in Turkey. The purpose of this study was to investigate the epidemiological and clinical data of IgA nephropathy patients in Turkey. Method 4399 patients with primary glomerular diseases from 47 centers who were followed up between May 2009 and May 2019 were included in the study conducted by TSN-GOLD Working Group. 524 patients were excluded due to lack of pathological data. Among the remaining patients, demographic, clinical and laboratory data of 994 patients with IgA nephropathy were analyzed. Results The median age of the patients was 37 (28-47) years, and 37.3% of them were female. The laboratory and clinical data at the time of diagnosis is presented in Figure-1, and biopsy indications are described in Figure-2. The median number of glomeruli was 16 (IQR: 3.5-4.3), sclerotic glomeruli was 2 (IQR: 1-5), and segmental sclerotic glomeruli was 1 (IQR: 1-2). Exudative changes, subendothelial and subepithelial deposition were present in 566 patients (56.9%), 46 patients (4.6%) and in 38 patients (3.8%), respectively. 662 (66.1%) and 611 of the patients (61.4%) had tubular atrophy and interstitial fibrosis in varying degrees, respectively. 672 (%67.6) and 416 patients (%41.9) had interstitial inflammation and vascular changes, respectively. In immunofluorescence staining, 18%, 30.1%, 4.4%, 68% of the patients had IgG, IgM, C1q and C3 positivity, respectively. Crescentic glomeruli were detected in 227 patients (3.3 ± 3.1 glomeruli). Patients with crescentic glomeruli had significantly higher proteinuria and lower eGFR than the patients without [2203 mg/day (15-26078) vs 1807 mg/day (15-29112); p=0.001; 55.3 ml/min/1.73 m2 (3.72-141.9) vs 72 ml/min/1.73 m2 (3.84-150.81); p&lt;0.001, respectively]. Oxford classification was applied to 544 patients. Endocapillary hypercellularity (E1), mesengial hypercellularity (M1), tubular atrophy and interstitial fibrosis (T1 and T2), segmental sclerosis (S1) were present in 126 (13%), 425 (42.8%), 306 (30.8%) and 325 patients (%32.7), respectively. Proteinuria levels were higher in patients with endocapillary hypertrophy, mesengial hypercellularity, tubular atrophy-interstitial fibrosis and segmental sclerosis. eGFR levels were lower in patients with endocapillary hypertrophy, tubular atrophy-interstitial fibrosis and segmental sclerosis (Figure-3). Conclusion In this study we found that, the most common presentation of IgA nephropathy patients in our country was asymptomatic urinary abnormalities followed by nephritic and nephrotic syndrome. Higher proteinuria and lower eGFR values in patients with crescentic glomeruli, support the adoption of crescentic lesions in the new Oxford classification (MEST-C) to predict more precise outcome of IgA nephropathy patients. The high number of patients to whom the Oxford classification was applied provided us with the opportunity to examine the clinical reflections of pathological features. Evaluation of the follow-up data of the patients will give us the possibility to reveal the effect of initial clinical and pathological features on clinical findings and renal outcome.

scholarly journals Clinical and Military Outcomes of Kidney Diseases Diagnosed in Active Duty Service Members

2021 ◽  
Author(s):  
Trevor W Tobin ◽  
Christina M Yuan ◽  
Robert Nee ◽  
John S Thurlow
Keyword(s):  
Kidney Disease ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Military Service ◽  
Kidney Diseases ◽  
Immunoglobulin A ◽  
Active Duty ◽  
Histologic Diagnosis ◽  
Renal Biopsies

ABSTRACT Introduction Renal biopsy is a valuable tool for determining diagnosis, management, and prognosis of intrinsic kidney diseases. Indications for biopsy depend on the clinical presentation. Within the military, renal biopsies also enable medical review boards to make military service fitness assessments after diagnosis of a kidney disease. There are no recent studies evaluating kidney disease diagnoses and clinical outcomes after renal biopsy at military treatment facilities. Additionally, no studies have examined overall healthcare and military career outcomes following renal biopsy. Materials and Methods We retrospectively reviewed all native renal biopsies performed on active duty beneficiaries at the Walter Reed National Military Medical Center from 2005 to 2020. We determined the prevalence of those who progressed to end-stage kidney disease (ESKD), kidney transplantation, doubling of serum creatinine, nephrotic-range proteinuria (NRP; proteinuria &gt;3.5 g/day), medical evaluation board (MEB) outcomes, and death. The Armed Forces Health Longitudinal Technology Application and the Joint Legacy Viewer electronic medical record systems were used to access clinical and laboratory data at the time of biopsy and subsequent outcomes. Death data were collected using the Defense Suicide Prevention Office database. Results There were 169 patients in the cohort, with a mean follow-up of 7.3 years. Mean age was 32 years; 79% male; 48% white; and 37% black. Sixty-seven percentage of them were junior or senior enlisted. The most common indication for renal biopsy was concomitant hematuria and proteinuria (31%). The most common histologic diagnoses were immunoglobulin A (IgA) nephropathy (23%), followed by focal segmental glomerulosclerosis (FSGS; 17%) and lupus nephritis (12%). Eleven percentage of them progressed to ESKD, of whom 87% received a kidney transplant (10% overall). Thirty percentage of the patients progressed to NRP and 5% died. Forty-seven percentage of our patients underwent MEB after diagnosis, and of these, 84% were not retained for further military service. Although IgA nephropathy was the most commonly diagnosed condition, FSGS and lupus nephritis diagnoses were significantly more likely to result in MEB. Conclusions and Implications Immunoglobulin A nephropathy was the most frequent histologic diagnosis in active duty service members undergoing renal biopsy between 2005 and 2020. Despite being largely young and previously healthy, 11% progressed to ESKD and 5% died. A confirmed histologic diagnosis was associated with separation from the service and the end of military careers for 84% of the patients in the cohort who underwent MEB.

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