Grading system utilising the total score of Oxford classification for predicting renal prognosis in IgA nephropathy

Miyabe, Yoei; Karasawa, Kazunori; Akiyama, Kenichi; Ogura, Shota; Takabe, Tomo; Sugiura, Naoko; Seki, Momoko; Iwabuchi, Yuko; Hanafusa, Norio; Uchida, Keiko; Nitta, Kosaku; Moriyama, Takahito

doi:10.1038/s41598-021-82967-x

Cited by 14 publications

(12 citation statements)

References 29 publications

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“…And at the same time, hypertension seemed not to be an independent risk factor to the patients with arteriolar hyalinosis in this study, which is inconsistent with the study of Miyabe et al. [ 36 ]. The possible reasons are that pathological scoring systems for IgAN, such as Oxford classification, without considering arteriolar hyalinosis, and the MESTC primary are also included, while arteriolar hyalinosis is not included in multivariate regression analysis.…”

Section: Discussioncontrasting

confidence: 99%

Arteriolar hyalinosis and renal outcomes in patients with immunoglobulin A nephropathy

Shen

Xiao

et al. 2022

Renal Failure

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Background The relationship between arteriolar hyalinosis and renal progression in immunoglobulin A nephropathy (IgAN) is not fully understood. We aimed to investigate the clinicopathological features and outcomes of IgAN with or without arteriolar hyalinosis. Methods A total of 762 diagnosed with IgAN patients were retrospectively analyzed. We classified IgAN patients into two groups with or without arteriolar hyalinosis. Then, the clinicopathological characteristics of the two groups were compared. We used Kaplan–Meier survival analysis to compare the composite kidney outcome of the two groups and applied multivariate Cox regression analyses to test the association between arteriolar hyalinosis and composite kidney outcome. Results Overall, 412 (54.1%) patients had arteriolar hyalinosis, including 173 patients diagnosed with hypertension. IgAN patients with arteriolar hyalinosis were older and had higher proteinuria, urea, uric acid, and blood pressure, while lower eGFR than those without arteriolar hyalinosis. Subgroup analysis showed similar results in IgAN patients with hypertension. Kaplan–Meier survival analysis showed that IgAN patients with arteriolar hyalinosis had worse composite kidney outcome than those without arteriolar hyalinosis. In addition, subgroup analysis revealed that patients with hypertension have worse composite kidney outcome than those without hypertension. Multivariate Cox regression analyses confirm that arteriolar hyalinosis (HR 2.57; 95% CI 1.41–4.69; p = 0.002) is an independent risk factor for renal prognosis in IgAN patients. Conclusions Our study demonstrated that arteriolar hyalinosis is a common vascular lesion in IgAN patients. Arteriolar hyalinosis connects closely with hypertension, and arteriolar hyalinosis is an independent risk factor for renal prognosis in patients with IgAN.

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Section: Discussioncontrasting

confidence: 99%

Arteriolar hyalinosis and renal outcomes in patients with immunoglobulin A nephropathy

Shen

Xiao

et al. 2022

Renal Failure

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“…Interestingly, our ROC analysis demonstrated that a model that is based purely on histopathological data has almost the same predictive performance as the models that combine clinical and histopathological information. Recently, Miyabe et al, has demonstrated that the MEST C score could be utilized to predict prognosis in IgAN using a grading system were patients were classified into three groups, but the model has yet to be externally validated [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Utilizing the MEST score for prognostic staging in IgA nephropathy

et al. 2022

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Background The Oxford classification/MEST score is an established histopathologic scoring system for patients with IgA nephropathy (IgAN). The objective of this study was to derive a prognostic model for IgAN based on the MEST score and histopathologic features. Methods A total of 306 patients with biopsy-proven primary IgAN were included. Histopathologic samples were retrieved from the Norwegian Kidney Biopsy Registry and reclassified according to the Oxford classification. The study endpoint was end-stage renal disease (ESRD). Patients were subclassified into three risk models based on histologic features (Model A), a composite score calculated from the adjusted hazard ratio values (Model B), and on quartiles (Model C). Results The mean follow-up time was 16.5 years (range 0.2–28.1). In total, 61 (20%) patients reached ESRD during the study period. Univariate analysis of M, E, S, T and C lesions demonstrated that all types were associated with an increased risk of ESRD; however, a multivariate analysis revealed that only S, T and C lesions were associated with poor outcomes. Statistical analysis of 15-year data demonstrated that Models A and B were as predictive as the MEST score, with an area-under-the-curve at 0.85. The Harrel c index values were 0.81 and 0.80 for the MEST score and Models A and B, respectively. In the present cohort, adding C lesions to the MEST score did not improve the models prognostic value. Conclusions Patients can be divided into risk classes based on their MEST scores. Histopathologic data provide valuable prognostic information at the time of diagnosis. Model B was the most suitable for clinical practice because it was the most user-friendly.

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“…Due to the widespread use of RASB, its effect on prognosis is underestimated. Some previous studies had not found that RASB has an independent prognostic effect on IgAN [ 39 , 40 ]. The effect of age on the prognosis of IgAN patients remains controversial [ 28 , 33 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Traditional Chinese Medicine Syndrome Elements and Prognosis of Patients with IgA Nephropathy

Duan

Liu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. It is not clear which Traditional Chinese Medicine- (TCM-) related elements affect primary IgA nephropathy (IgAN) progression. Here, we explored the risk factors, based on TCM syndrome elements, related to the prognosis of primary IgAN patients. Methods. We analyzed patients with newly diagnosed, biopsy-proven IgAN at a single institution from December 2013 to September 2021. Basic clinical and pathological characteristics were assessed at the time of renal biopsy. The study endpoint was end-stage renal disease (ESRD: eGFR <15 ml/min per 1.73 m2, dialysis, or kidney transplantation) and/or eGFR decreased by >30% from baseline. Kaplan‒Meier survival analysis was used to explore the role of TCM syndrome elements in IgAN progression. Multivariate Cox regression analysis with adjustment for traditional risk factors was performed to explore TCM syndrome elements that may influence patient prognosis. The factors correlated with TCM syndrome elements in IgAN patients were further evaluated by logistic regression analysis. Results. During a median follow-up of 22.0 months, 53 (12.5%) of the 423 included IgAN patients reached the study endpoint. The main IgAN disease location elements were the kidney, liver, and spleen. The main IgAN disease nature elements were Yin-deficiency and Qi-deficiency, dampness, Yang-deficiency, phlegm, and Blood-deficiency. Kaplan‒Meier analysis identified three disease locations (liver, spleen, and kidney) and four disease natures (Qi-deficiency, Yang-deficiency, phlegm, and dampness) as elements associated with poor renal survival in IgAN patients. In multivariate Cox regression analysis, baseline Yang-deficiency was an independent risk predictor of poor prognosis in primary IgAN patients (hazard ratio 2.338; 95% confidence interval [CI]: 1.208–4.525; P = 0.012 ) after adjustment for traditional risk factors. Furthermore, logistic regression analysis identified being female (odds ratio [OR] 2.518; 95% CI: 1.538–4.122; P < 0.001 ), older age (OR 1.043; 95% CI: 1.022–1.065; P < 0.001 ), low hemoglobin levels (OR 0.984; 95% CI: 0.971–0.996; P = 0.013 ), and cellular/fibrocellular crescents (OR 1.706; 95% CI: 1.068–2.728; P = 0.026 ) as factors affecting Yang-deficiency in IgAN patients. Conclusions. Yang-deficiency independently predicts the risk of poor prognosis in primary IgAN patients. Being female, older age, low hemoglobin levels, and cellular/fibrocellular crescents were independently associated with Yang-deficiency in IgAN patients.

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Grading system utilising the total score of Oxford classification for predicting renal prognosis in IgA nephropathy

Cited by 14 publications

References 29 publications

Arteriolar hyalinosis and renal outcomes in patients with immunoglobulin A nephropathy

Arteriolar hyalinosis and renal outcomes in patients with immunoglobulin A nephropathy

Utilizing the MEST score for prognostic staging in IgA nephropathy

Relationship between Traditional Chinese Medicine Syndrome Elements and Prognosis of Patients with IgA Nephropathy

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