The 1-year Renal Biopsy Index: a scoring system to drive biopsy indication at 1-year post-kidney transplantation

Giral, Magali; Renaudin, Karine; Naesens, Maarten; Luning, Redmer; Anglicheau, Dany; Morélon, Emmanuel; Huneau, Alexandre; Paul, Chloé; Brouard, Sophie; Couvrat-Desvergnes, Grégoire; Foucher, Yohann; Dantan, Étienne

doi:10.1111/tri.13290

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…LASSO regression is one of the most useful tools to select features for classification and survival prognosis determination ( Song et al, 2020 ). It can obtain fewer and more representative variable combinations from a large number of variables while avoiding model overfitting ( Giral et al, 2018 ; Patel et al, 2018 ). However, LASSO regression also has shortcomings.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

et al. 2022

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BackgroundIntracerebral hemorrhage (ICH) is a stroke syndrome with an unfavorable prognosis. Currently, there is no comprehensive clinical indicator for mortality prediction of ICH patients. The purpose of our study was to construct and evaluate a nomogram for predicting the 30-day mortality risk of ICH patients.MethodsICH patients were extracted from the MIMIC-III database according to the ICD-9 code and randomly divided into training and verification cohorts. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to determine independent risk factors. These risk factors were used to construct a nomogram model for predicting the 30-day mortality risk of ICH patients. The nomogram was verified by the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA).ResultsA total of 890 ICH patients were included in the study. Logistic regression analysis revealed that age (OR = 1.05, P < 0.001), Glasgow Coma Scale score (OR = 0.91, P < 0.001), creatinine (OR = 1.30, P < 0.001), white blood cell count (OR = 1.10, P < 0.001), temperature (OR = 1.73, P < 0.001), glucose (OR = 1.01, P < 0.001), urine output (OR = 1.00, P = 0.020), and bleeding volume (OR = 1.02, P < 0.001) were independent risk factors for 30-day mortality of ICH patients. The calibration curve indicated that the nomogram was well calibrated. When predicting the 30-day mortality risk, the nomogram exhibited good discrimination in the training and validation cohorts (C-index: 0.782 and 0.778, respectively). The AUCs were 0.778, 0.733, and 0.728 for the nomogram, Simplified Acute Physiology Score II (SAPSII), and Oxford Acute Severity of Illness Score (OASIS), respectively, in the validation cohort. The IDI and NRI calculations and DCA analysis revealed that the nomogram model had a greater net benefit than the SAPSII and OASIS scoring systems.ConclusionThis study identified independent risk factors for 30-day mortality of ICH patients and constructed a predictive nomogram model, which may help to improve the prognosis of ICH patients.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

et al. 2022

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“…When serum creatinine levels rise or eGFR falls, allograft damage may have progressed to the point that it is no longer reversible [4]. Accordingly, allograft biopsy was considered the golden choice to analyze allograft injury and differentiate among the different etiologies, despite its impediments, such as infection, bleeding, and even allograft loss [5]. However, the regular evaluation of CAI still can not be exactly.…”

Section: Introductionmentioning

confidence: 99%

Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging

Zheng

Wang

et al. 2021

BMC Med Imaging

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Background Chronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI. Methods Between February 2019 and October 2019, 110 renal allograft recipients were included to analyze relevant DKI parameters. According to estimated glomerular filtration rate (eGFR) (mL/min/ 1.73 m2) level, they were divided to 3 groups: group 1, eGFR ≥ 60 (n = 10); group 2, eGFR 30–60 (n = 69); group 3, eGFR < 30 (n = 31). We performed DKI on a clinical 3T magnetic resonance imaging system. We measured the area of interest to determine the mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) of the renal cortex and medulla. We performed a Pearson correlation analysis to determine the relationship between eGFR and the DKI parameters. We used the receiver operating characteristic curve to estimate the predicted values of DKI parameters in the CAI evaluation. We randomly selected five patients from group 2 for biopsy to confirm CAI. Results With the increase of creatinine, ADC, and MD of the cortex and medulla decrease, MK of the cortex and medulla gradually increase. Among the three different eGFR groups, significant differences were found in cortical and medullary MK (P = 0.039, P < 0.001, P < 0.001, respectively). Cortical and medullary ADC and MD are negatively correlated with eGFR (r = − 0.49, − 0.44, − 0.57, − 0.57, respectively; P < 0.001), while cortical and medullary MK are positively correlated with eGFR (r = 0.42, 0.38; P < 0.001). When 0.491 was set as the cutoff value, MK's CAI assessment showed 87% sensitivity and 100% specificity. All five patients randomly selected for biopsy from the second group confirmed glomerulosclerosis and tubular atrophy/interstitial fibrosis. Conclusion The DKI technique is related to eGFR as allograft injury progresses and is expected to become a potential non-invasive method for evaluating CAI.

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“…Processes at the molecular level involved in chronic allograft injury occur very early, but they do not manifest clinically and cannot be detected by standard methods [7]. Currently, assessment of IFTA is only possible with renal biopsy, which is an invasive procedure [8]. Postoperative management of kidney transplant recipients includes protocolar biopsies which are performed without specific clinical indications to detect subclinical changes [9].…”

Section: Introductionmentioning

confidence: 99%

Urinary MicroRNA-21-5p as Potential Biomarker of Interstitial Fibrosis and Tubular Atrophy (IFTA) in Kidney Transplant Recipients

et al. 2020

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Chronic renal allograft dysfunction (CAD) is a major limiting factor of long-term graft survival. The hallmarks of progressive CAD are interstitial fibrosis and tubular atrophy (IFTA). MicroRNAs are small, regulatory RNAs involved in many immunological processes. In particular, microRNA-21-5p (miR-21) is considered to be strongly associated with pathogenesis regarding tubulointerstitium. The aim of this study was to assess urinary miR-21 expression levels in the kidney transplant recipients and determine their application in the evaluation of IFTA and kidney allograft function. The expression levels of miR-21 were quantified in the urine of 31 kidney transplant recipients with biopsy-assessed IFTA (IFTA 0 + I: n = 17; IFTA II + III: n = 14) by real-time quantitative PCR. Urine samples were collected at the time of protocolar biopsies performed 1 or 2 years after kidney transplantation. MicroRNA-191-5p was used as reference gene. MiR-21 was significantly up-regulated in IFTA II + III group compared to IFTA 0 + I group (p = 0.003). MiR-21 correlated significantly with serum concentration of creatinine (r = 0.52, p = 0.003) and eGFR (r = −0.45; p = 0.01). ROC analysis determined the diagnostic value of miR-21 with an area under curve (AUC) of 0.80 (p = 0.0002), sensitivity of 0.86 and specificity of 0.71. miR-21 is associated with renal allograft dysfunction and IFTA. Therefore, it could be considered as a potential diagnostic, non-invasive biomarker for monitoring renal graft function.

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The 1-year Renal Biopsy Index: a scoring system to drive biopsy indication at 1-year post-kidney transplantation

Cited by 8 publications

References 26 publications

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage

Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging

Urinary MicroRNA-21-5p as Potential Biomarker of Interstitial Fibrosis and Tubular Atrophy (IFTA) in Kidney Transplant Recipients

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