Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis

The classification of podocytopathies, including minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), has historically been based on limited glomerular features. This study used supervised machine learning methods to identify the most important clinical and histopathologic predictors of disease progression, complete proteinuria remission, and treatment response in MCD/FSGS. The top predictors included conventional and novel glomerular and tubulointerstitial features. Biopsy reporting for podocytopathies should be standardized by including these prognostic morphologic features to inform risk stratification.