Age-adjusted global glomerulosclerosis predicts renal progression more accurately in patients with IgA nephropathy

Abstract

The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN). Based on the upper reference limit (95 th percentile) for the number of globally sclerotic glomeruli (GSG) expected on biopsy according to age, we evaluated whether the prognosis of IgAN was affected by the agecalibrated numbers of GSG independent of the Oxford classification. Patients diagnosed with IgAN on renal biopsy in a single center from January 2011 to December 2018 were analyzed retrospectively. patients with more GSG number than the upper reference limit expected on biopsy according to age were categorized in a group of GSG abnormal for age. We analyzed in two ways, calculating the median rate of decline in estimated glomerular filtration rate (eGFR) and time-to-event defined as a decline of eGFR level to 40% lower than the baseline. There were 111 patients in the group of GSG abnormal for age. In this group, the rate of eGFR decline was faster by 1.85 (3.68-0.03) ml/min/1.73 m 2 per year in the fully-adjusted robust regression model. The adjusted hazard ratio for eGFR decline for renal outcome was 29.10 (2.18-388.49). The cumulative incidence of CKD progression was significantly higher, especially for those with T score of 0 in the Oxford classification. We suggest that GSG abnormal for age is an independent risk factor in predicting the renal outcome of IgAN.

Comparative analysis of hypertensive nephrosclerosis in animal models of hypertension and its relevance to human pathology. Glomerulopathy

“…Optimization in analysis of pathologic variables is constantly improved by testing sensitivity, specificity, and predictive values for differences in clinical features and renoprotective treatment [ 41 , 47 , 48 , 61 ]. In human pathology, lesional variables are identified and optimized in order to predict progression, outcome, and response to therapy [ 21 , 42 , 43 , 62 , 63 ]. Unfortunately, in animal studies histopathologic features only indicate the presence of lesions but not the severity because there are no commonly accepted values and each study makes assumptions based on particular set of scale values.…”

Clinicopathological Characteristics of Adult IgA Nephropathy in the United States

“…Few studies have reported the histological characteristics identified via kidney biopsy in adult patients with IgAN and the impact on disease progression. 16 , 20 , 21 , 22 , 23 Given the frequently asymptomatic presentation of IgAN and the potential negative implications of uncontrolled disease on long-term prognosis, we sought to characterize disease stage and histological patterns in a modern large real-world cohort of US adult patients with IgAN at the time of kidney biopsy. We further examined potential associations between MEST-C scores and 24-hour proteinuria as well as CKD stage at the time of diagnosis.…”

Global glomerulosclerosis proportions above 10% predict nephropathy progression in IgA Nephropathy: a multicenter retrospective analysis with propensity score matching

“…However, the original Oxford study included a limited small sample size and excluded severe IgAN patients. Furthermore, recent reports indicated that GS is a strong predictor of long-term renal outcomes independent of T score in IgAN patients [8,9]. Then this retrospective three-center cohort study with a larger sample size and a longer follow-up was performed to explore the relationship between GS and renal outcomes in IgAN patients.…”