Validation of a Histologic Scoring Index for C3 Glomerulopathy.
Adolescent
Adult
Atrophy
Child
Cohort Studies
Complement C3
/ immunology
Disease Progression
Female
Fibrosis
Glomerular Filtration Rate
Glomerulonephritis
/ drug therapy
Glomerulonephritis, Membranoproliferative
/ drug therapy
Humans
Immunosuppressive Agents
/ therapeutic use
Kidney
/ pathology
Kidney Tubules
/ pathology
Male
Middle Aged
Prognosis
Proportional Hazards Models
Proteinuria
Renal Insufficiency
/ immunology
Reproducibility of Results
Retrospective Studies
Young Adult
C3 glomerulonephritis (C3GN)
C3 glomerulopathy (C3G)
dense-deposit disease (DDD)
disease prognosis
histologic index
intraclass correlations
kidney biopsy
kidney failure
kidney survival
prognostic tool
total activity Score
total chronicity score
Journal
American journal of kidney diseases : the official journal of the National Kidney Foundation
ISSN: 1523-6838
Titre abrégé: Am J Kidney Dis
Pays: United States
ID NLM: 8110075
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
24
04
2020
accepted:
06
11
2020
pubmed:
29
12
2020
medline:
11
5
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
A previous study that evaluated associations of kidney biopsy findings with disease progression in patients with C3 glomerulopathy (C3G) proposed a prognostic histologic index (C3G-HI) that has not yet been validated. Our objective was to validate the performance of the C3G-HI in a new patient population. Multicenter, retrospective cohort study. 111 patients fulfilling diagnostic criteria of C3G between January 1995 and December 2019, from 33 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). Demographic, clinical parameters, C3G-HI total activity score, and the C3G-HI total chronicity score. Time to kidney failure. Intraclass correlation coefficients and κ statistic were used to summarize inter-rater reproducibility for assessment of histopathology in kidney biopsies. The nonlinear relationships of risk of kidney failure with the total activity score and total chronicity score were modeled using Cox proportional hazards analysis that incorporated cubic splines. The study group included 93 patients with C3 glomerulonephritis and 18 with dense-deposit disease. Participants had an overall meanage of 35±22 (SD) years. Forty-eight patients (43%) developed kidney failure after a mean follow-up of 65±27 months. The overall inter-rater reproducibility was very good for the total activity score (intraclass correlation coefficient [ICC]=0.63) and excellent for total chronicity score (ICC=0.89). Baseline estimated glomerular filtration rate (eGFR), 24-hour proteinuria, and treatment with immunosuppression were the main determinants of kidney failure in a model with only clinical variables. Only tubular atrophy and interstitial fibrosis were identified as predictors in a model with histological variables. When the total activity score and total chronicity score were added to the model, only the latter was identified as an independent predictor of kidney failure. Only a subset of the kidney biopsies was centrally reviewed. Residual confounding. We validated the performance of C3G-HI as a predictor of kidney failure in patients with C3G. The total chronicity score was the principal histologic correlate of kidney failure.
Identifiants
pubmed: 33359150
pii: S0272-6386(20)31160-4
doi: 10.1053/j.ajkd.2020.11.011
pii:
doi:
Substances chimiques
Complement C3
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
684-695.e1Investigateurs
Teresa Cavero
(T)
Ángel Sevillano
(Á)
Eduardo Gutiérrez
(E)
Enrique Morales
(E)
Lucia González
(L)
Rafael Camacho Galán
(R)
Alejandra Gabaldón Domínguez
(A)
Marta Garrido
(M)
Alexandra Navarro
(A)
José Antonio Cortés
(JA)
Alejando Pascual Martin
(A)
M Luisa Pérez-Ebri
(ML)
Rocío Cabrera-Pérez
(R)
Ángel Panizo Santos
(Á)
Laura Yébenes Gregorio
(L)
Maria Eugenia García Fernández
(ME)
Javier Gimeno
(J)
Pablo Cannata Ortiz
(P)
Esther Roselló Sastre
(E)
Ana Saiz
(A)
Eduardo Salido Ruiz
(E)
Rosa Rodríguez
(R)
Cesáreo Corbacho Cuevas
(C)
Francisco Díaz Crespo
(FD)
Yolanda Arce
(Y)
Maria Soledad Garcia-Cuerva Calvar
(MS)
Carles Saus
(C)
Carmen Guerrero Márquez
(C)
Adriana García-Herrera
(A)
Montserrat Gomà Gallego
(M)
Dolores López Álvarez
(D)
Cristina Meléndez Muñoz
(C)
Macarena Centeno
(M)
Belén Ferri Ñíguez
(B)
Juan Mosquera Reboredo
(J)
Eduardo Vázquez Martul
(E)
Sofía Pérez Gutiérrez
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.