Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update.

Adolescent Adult Child Cohort Studies Disease Progression Female Follow-Up Studies Glomerular Filtration Rate Glomerulonephritis, IGA / classification Humans Kidney / physiopathology Male Prognosis

IgA nephropathy progression renal biopsy risk factors

Journal

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

ISSN: 1460-2385

Titre abrégé: Nephrol Dial Transplant

Pays: England

ID NLM: 8706402

Informations de publication

Date de publication:
01 06 2020

Historique:

received: 28 06 2018

accepted: 13 08 2018

pubmed: 13 11 2018

medline: 24 11 2020

entrez: 13 11 2018

Statut: ppublish

Résumé

It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up. 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)]. 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%). 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.

Sections du résumé

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.

Identifiants

DOI: 10.1093/ndt/gfy302 PMID: 30418652

pubmed: 30418652

pii: 5168375

doi: 10.1093/ndt/gfy302

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Validation Study

Langues

eng

Sous-ensembles de citation

Pagination

1002-1009

Investigateurs

V Tesar (V)

D Maixnerova (D)

S Lundberg (S)

L Gesualdo (L)

F Emma (F)

L Fuiano (L)

G Beltrame (G)

C Rollino (C)

R Coppo (R)

A Amore (A)

R Camilla (R)

L Peruzzi (L)

M Praga (M)

S Feriozzi (S)

R Polci (R)

G Segoloni (G)

L Colla (L)

A Pani (A)

A Angioi (A)

L Piras (L)

J Feehally (J)

G Cancarini (G)

S Ravera (S)

M Durlik (M)

E Moggia (E)

J Ballarin (J)

S Di Giulio (S)

F Pugliese (F)

I Serriello (I)

Y Caliskan (Y)

M Sever (M)

I Kilicaslan (I)

F Locatelli (F)

L Del Vecchio (L)

J F M Wetzels (JFM)

H Peters (H)

U Berg (U)

F Carvalho (F)

A C da Costa Ferreira (AC)

M Maggio (M)

A Wiecek (A)

M Ots-Rosenberg (M)

R Magistroni (R)

R Topaloglu (R)

Y Bilginer (Y)

M D'Amico (M)

M Stangou (M)

F Giacchino (F)

D Goumenos (D)

M Papastirou (M)

K Galesic (K)

L Toric (L)

C Geddes (C)

K Siamopoulos (K)

O Balafa (O)

M Galliani (M)

P Stratta (P)

M Quaglia (M)

R Bergia (R)

R Cravero (R)

M Salvadori (M)

L Cirami (L)

B Fellstrom (B)

H Kloster Smerud (H)

F Ferrario (F)

T Stellato (T)

J Egido (J)

C Martin (C)

J Floege (J)

F Eitner (F)

T Rauen (T)

A Lupo (A)

P Bernich (P)

P Menè (P)

M Morosetti (M)

C van Kooten (C)

T Rabelink (T)

M E J Reinders (MEJ)

J M Boria Grinyo (JM)

S Cusinato (S)

L Benozzi (L)

S Savoldi (S)

C Licata (C)

M Mizerska-Wasiak (M)

M Roszkowska-Blaim (M)

G Martina (G)

A Messuerotti (A)

A Dal Canton (A)

C Esposito (C)

C Migotto (C)

G Triolo (G)

F Mariano (F)

C Pozzi (C)

R Boero (R)

G Mazzucco (G)

C Giannakakis (C)

E Honsova (E)

B Sundelin (B)

A M Di Palma (AM)

F Ferrario (F)

E Gutiérrez (E)

A M Asunis (AM)

J Barratt (J)

R Tardanico (R)

A Perkowska-Ptasinska (A)

J Arce Terroba (J)

M Fortunato (M)

A Pantzaki (A)

Y Ozluk (Y)

E Steenbergen (E)

M Soderberg (M)

Z Riispere (Z)

L Furci (L)

D Orhan (D)

D Kipgen (D)

D Casartelli (D)

D GalesicLjubanovic (D)

H Gakiopoulou (H)

E Bertoni (E)

P Cannata Ortiz (P)

H Karkoszka (H)

H J Groene (HJ)

A Stoppacciaro (A)

I Bajema (I)

J Bruijn (J)

X Fulladosa Oliveras (X)

J Maldyk (J)

E Ioachim (E)