Rosanna Coppo1, Graziella D'Arrigo2, Giovanni Tripepi2, Maria Luisa Russo1, Ian S D Roberts3, Shubha Bellur3, Daniel Cattran4, Terence H Cook5, John Feehally6, Vladimir Tesar7, Dita Maixnerova7, Licia Peruzzi8, Alessandro Amore8, Sigrid Lundberg9, Anna Maria Di Palma10, Loreto Gesualdo10, Francesco Emma11, Cristiana Rollino12, Manuel Praga13, Luigi Biancone14, Antonello Pani15, Sandro Feriozzi16, Rosaria Polci16, Jonathan Barratt6, Lucia Del Vecchio17, Francesco Locatelli17, Alessandro Pierucci18, Yasar Caliskan19, Agnieszka Perkowska-Ptasinska20, Magdalena Durlik20, Elisabetta Moggia21, José C Ballarin22, Jack F M Wetzels23, Dimitris Goumenos24, Marios Papasotiriou24, Kresimir Galesic25, Luka Toric25, Aikaterini Papagianni26, Maria Stangou26, Luisa Benozzi27, Stefano Cusinato27, Ulla Berg28, Rezan Topaloglu29, Milena Maggio30, Mai Ots-Rosenberg31, Marco D'Amico32, Colin Geddes33, Olga Balafa34, Marco Quaglia35, Raffaella Cravero36, Calogero Lino Cirami37, Bengt Fellstrom38, Jürgen Floege39, Jesus Egido40, Francesca Mallamaci2, Carmine Zoccali2. 1. Fondazione Ricerca Molinette, Turin, Piemonte, Italy. 2. CNR-IFC, Epidemiology, Reggio Calabria, Italy. 3. Cellular Pathology, Oxford University Hospital, Oxford, UK. 4. University, Toronto GH, Toronto, ON, Canada. 5. Department of Nephrology, Imperial College, London, UK. 6. Department of Nephrology, Leicester General Hospital, Leicester, UK. 7. Nephrology, General University Hospital, Prague, Czech Republic. 8. Nephrology, Regina Margherita Hospital, Turin, Italy. 9. Department of Nephrology, Karolinska Institutet, Stockholm, Sweden. 10. Department of Nephrology, BFU, Bari, Italy. 11. Department of Nephrology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy. 12. Department of Nephrology and Dialysis, OSGB, Turin, Italy. 13. Department of Nephrology, H12Octubre, Madrid, Spain. 14. Department of Nephrology, CSST, Turin, Italy. 15. Department of Nephrology, AOGB, Cagliari, Italy. 16. Department of Nephrology, Belcolle Hospital, Viterbo, Italy. 17. Department of Nephrology, OAM, Lecco, Italy. 18. Department of Nephrology, Sapienza University, Rome, Italy. 19. Nephrology, Istanbul University, Istanbul, Turkey. 20. Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland. 21. Department of Nephrology, Santa Croce Hospital, Cuneo, Italy. 22. Department of Nephrology, Puigvert, Barcelona, Spain. 23. Department of Nephrology and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 24. Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece. 25. Department of Nephrology, Dubrava University, Zagreb, Croatia. 26. Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece. 27. Department of Nephrology, Borgomanero, Italy. 28. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Huddinge, Sweden. 29. Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine Ankara, Turkey. 30. Department of Nephrology, Hospital Maggiore di Lodi, Lodi, Italy. 31. Department of Nephrology, Tartu University Clinics, Tartu, Estonia. 32. Nephrology, S. Anna Hospital, Como, Colorado, Italy. 33. Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK. 34. Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece. 35. Department of Nephrology, Maggiore della Carità Hospital, Piem, Onte Orientale University, Novara, Italy. 36. Nephrology, Degli Infermi Hospital, Biella, Italy. 37. Department of Nephrology, Careggi Hospital, Florence, Italy. 38. Renal Department, University of Uppsala, Uppsala, Sweden. 39. Division of Nephrology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany. 40. Department of Nephrology, Fundacion Jimenez Diaz, CIBERDEM, Madrid, Spain.
Abstract
BACKGROUND: It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up. METHODS: In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1-10.8)]. RESULTS: In this extended analysis, M1, S1 and T1-T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%). CONCLUSION: Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
BACKGROUND: It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up. METHODS: In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1-10.8)]. RESULTS: In this extended analysis, M1, S1 and T1-T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%). CONCLUSION: Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
Authors: Elise Marechal; Adrien Jaugey; Georges Tarris; Michel Paindavoine; Jean Seibel; Laurent Martin; Mathilde Funes de la Vega; Thomas Crepin; Didier Ducloux; Gilbert Zanetta; Sophie Felix; Pierre Henri Bonnot; Florian Bardet; Luc Cormier; Jean-Michel Rebibou; Mathieu Legendre Journal: Clin J Am Soc Nephrol Date: 2021-12-03 Impact factor: 8.237
Authors: Taylor Person; R Glenn King; Dana V Rizk; Jan Novak; Todd J Green; Colin Reily Journal: J Interferon Cytokine Res Date: 2022-07-06 Impact factor: 3.657
Authors: Ricong Xu; Zhijian Li; Tao Cao; Yi Xu; Ying Liao; Haiying Song; Xiaojie Chen; Fei Tang; Qiong Xiang; Qijun Wan Journal: Int J Gen Med Date: 2021-06-18