Ilaria Serriello1, Rosaria Polci1, Sandro Feriozzi1, Antonietta Gigante2, Salvatore Di Giulio3, Margherita Rosa3, Marco Galliani4, Massimo Morosetti5, Francesco Pugliese6, Tommasangelo Petitti7, Andrea Onetti Muda8, Konstantinos Giannakakis9. 1. Nephrology and Dialysis Department, Belcolle Hospital, Viterbo, Italy. 2. Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy. 3. Nephrology, Dialysis and Transplantation Department, San Camillo Hospital, Rome, Italy. 4. Nephrology and Dialysis Department, S. Pertini Hospital, Rome, Italy. 5. Nephrology and Dialysis Department G.B. Grassi Hospital, Ostia, Rome, Italy. 6. Nephrology and Dialysis A Unit, Sapienza University of Rome, Rome, Italy. 7. Health Department, University Campus Biomedico, Rome, Italy. 8. Department of Medicine and Surgery, Pathology Unit, Campus Bio-Medico University of Rome, Rome, Italy. 9. Department of Radiology, Oncology, Radiology and Pathology, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: Oxford classification of Immunoglobulin A Nephropathy (IgAN) identifies four pathological features as predictors of renal outcome (MEST-score): mesangial proliferation (M); endocapillary proliferation (E); segmental glomerulosclerosis (S); tubular atrophy/interstitial fibrosis (T). In particular extracapillary proliferation (Ex) was not considered as an independent histological variable predicting renal outcome. Recently the VALIGA study provided a validation of the Oxford classification in a large European cohort of IgAN patients and re-stated that Ex is not associated with a worse renal prognosis. We propose a retrospective study to evaluate the predictive value of the MEST-score in a multi-centre, single region group of patients from central Italy and in addition, to investigate Ex as a marker predicting renal outcome. METHODS: One hundred and seven patients were enrolled in this study. Clinical data of each patient were available at diagnosis and follow-up. The median age at diagnosis was 36.7 years; 72% of the patients were males. Histological parameters were those included in the MEST-score of the Oxford classification; in addition, Ex was also assessed. RESULTS: Multiple linear regression models for survey were used. Statistical analysis showed a correlation between the progression of renal decline, in terms of estimated glomerular filtration rate (slope eGFR), and M, S, T. Differently from Oxford and VALIGA studies, no correlation was found with E, while Ex correlated with a decline of eGFR. CONCLUSIONS: Our results suggest that Ex represents an additional independent variable associated with a faster decline of renal function in IgAN.
BACKGROUND: Oxford classification of Immunoglobulin A Nephropathy (IgAN) identifies four pathological features as predictors of renal outcome (MEST-score): mesangial proliferation (M); endocapillary proliferation (E); segmental glomerulosclerosis (S); tubular atrophy/interstitial fibrosis (T). In particular extracapillary proliferation (Ex) was not considered as an independent histological variable predicting renal outcome. Recently the VALIGA study provided a validation of the Oxford classification in a large European cohort of IgANpatients and re-stated that Ex is not associated with a worse renal prognosis. We propose a retrospective study to evaluate the predictive value of the MEST-score in a multi-centre, single region group of patients from central Italy and in addition, to investigate Ex as a marker predicting renal outcome. METHODS: One hundred and seven patients were enrolled in this study. Clinical data of each patient were available at diagnosis and follow-up. The median age at diagnosis was 36.7 years; 72% of the patients were males. Histological parameters were those included in the MEST-score of the Oxford classification; in addition, Ex was also assessed. RESULTS: Multiple linear regression models for survey were used. Statistical analysis showed a correlation between the progression of renal decline, in terms of estimated glomerular filtration rate (slope eGFR), and M, S, T. Differently from Oxford and VALIGA studies, no correlation was found with E, while Ex correlated with a decline of eGFR. CONCLUSIONS: Our results suggest that Ex represents an additional independent variable associated with a faster decline of renal function in IgAN.
Authors: Jhonny L Moreno; Lida M Rodas; Juliana Draibe; Xavier Fulladosa; Montserrat Gomá; Adriana Garcia-Herrera; Josep M Cruzado; Joan Torras; Luis F Quintana Journal: Clin Kidney J Date: 2019-11-09