Di Xie1, Hao Zhao1, Xin Xu1, Zhanmei Zhou1, Cailing Su1, Nan Jia1, Youhua Liu1, Fan Fan Hou2. 1. National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2. National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China ffhouguangzhou@163.com.
Abstract
BACKGROUND: The lack of a tool for predicting the response to immunosuppressive therapy in IgA nephropathy (IgAN) limits patient-specific risk stratification and early treatment decision making. Models for predicting response to immunosuppression in IgAN that can be applied at the time of kidney biopsy are needed. METHODS: This prospective cohort study involved 621 Chinese patients with IgAN who were at high risk for disease progression and had persistent proteinuria ≥1 g/d, despite 3 months of optimized supportive care with renin-angiotensin system inhibitors. Participants received immunosuppressive therapy for a median of 18 months. We used immunochemistry to identify macrophage and lymphocyte infiltrates in biopsy specimens and digital image analysis to quantify them. The outcome was response to immunosuppression, defined as complete or partial remission within 12 months of immunosuppression. RESULTS: Kidney infiltration of CD68+ and CD206+ macrophages increased in patients with IgAN. Having higher levels of glomerular CD206+ macrophage infiltration was associated with a 40-fold increased probability of response to immunosuppression in adjusted analysis compared with having lower levels. Patients with a higher intensity of glomerular CD68+ infiltrates had a 13-fold increase in probability of responding to immunosuppression. Intensity of glomerular CD206+ and CD68+ macrophage infiltration predicted the response to immunosuppression (area under the curve [AUC], 0.84; 95% CI, 0.81 to 0.88). The AUC increased to 0.87 (95% CI, 0.84 to 0.91) in a model combining the infiltration score of CD206+ and CD68+ infiltrates with the MEST-C score and clinical data at biopsy. CONCLUSIONS: Intensity of glomerular macrophage infiltration predicted response to immunosuppressive therapy in patients with IgAN who were at high risk of progression, and may help physicians identify patients who will benefit from such treatment.
BACKGROUND: The lack of a tool for predicting the response to immunosuppressive therapy in IgA nephropathy (IgAN) limits patient-specific risk stratification and early treatment decision making. Models for predicting response to immunosuppression in IgAN that can be applied at the time of kidney biopsy are needed. METHODS: This prospective cohort study involved 621 Chinese patients with IgAN who were at high risk for disease progression and had persistent proteinuria ≥1 g/d, despite 3 months of optimized supportive care with renin-angiotensin system inhibitors. Participants received immunosuppressive therapy for a median of 18 months. We used immunochemistry to identify macrophage and lymphocyte infiltrates in biopsy specimens and digital image analysis to quantify them. The outcome was response to immunosuppression, defined as complete or partial remission within 12 months of immunosuppression. RESULTS: Kidney infiltration of CD68+ and CD206+ macrophages increased in patients with IgAN. Having higher levels of glomerular CD206+ macrophage infiltration was associated with a 40-fold increased probability of response to immunosuppression in adjusted analysis compared with having lower levels. Patients with a higher intensity of glomerular CD68+ infiltrates had a 13-fold increase in probability of responding to immunosuppression. Intensity of glomerular CD206+ and CD68+ macrophage infiltration predicted the response to immunosuppression (area under the curve [AUC], 0.84; 95% CI, 0.81 to 0.88). The AUC increased to 0.87 (95% CI, 0.84 to 0.91) in a model combining the infiltration score of CD206+ and CD68+ infiltrates with the MEST-C score and clinical data at biopsy. CONCLUSIONS: Intensity of glomerular macrophage infiltration predicted response to immunosuppressive therapy in patients with IgAN who were at high risk of progression, and may help physicians identify patients who will benefit from such treatment.
Authors: Jiri Mestecky; Milan Raska; Bruce A Julian; Ali G Gharavi; Matthew B Renfrow; Zina Moldoveanu; Lea Novak; Karel Matousovic; Jan Novak Journal: Annu Rev Pathol Date: 2012-10-18 Impact factor: 23.472
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