TY - JOUR
T1 - Is there long-term value of pathology scoring in immunoglobulin A nephropathy?
T2 - A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update
AU - European Renal Association
AU - Coppo, Rosanna
AU - D'Arrigo, Graziella
AU - Tripepi, Giovanni
AU - Russo, Maria Luisa
AU - Roberts, Ian S D
AU - Bellur, Shubha
AU - Cattran, Daniel
AU - Cook, Terence H
AU - Feehally, John
AU - Tesar, Vladimir
AU - Maixnerova, Dita
AU - Peruzzi, Licia
AU - Amore, Alessandro
AU - Lundberg, Sigrid
AU - Di Palma, Anna Maria
AU - Gesualdo, Loreto
AU - Emma, Francesco
AU - Rollino, Cristiana
AU - Praga, Manuel
AU - Biancone, Luigi
AU - Pani, Antonello
AU - Feriozzi, Sandro
AU - Polci, Rosaria
AU - Barratt, Jonathan
AU - Del Vecchio, Lucia
AU - Locatelli, Francesco
AU - Pierucci, Alessandro
AU - Caliskan, Yasar
AU - Perkowska-Ptasinska, Agnieszka
AU - Durlik, Magdalena
AU - Moggia, Elisabetta
AU - Ballarin, José C
AU - Wetzels, Jack F M
AU - Goumenos, Dimitris
AU - Papasotiriou, Marios
AU - Galesic, Kresimir
AU - Toric, Luka
AU - Papagianni, Aikaterini
AU - Stangou, Maria
AU - Benozzi, Luisa
AU - Cusinato, Stefano
AU - Berg, Ulla
AU - Topaloglu, Rezan
AU - Maggio, Milena
AU - Ots-Rosenberg, Mai
AU - D'Amico, Marco
AU - Geddes, Colin
AU - Balafa, Olga
AU - Quaglia, Marco
AU - Zoccali, Carmine
PY - 2018/11/9
Y1 - 2018/11/9
N2 - 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.
AB - 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.
U2 - 10.1093/ndt/gfy302
DO - 10.1093/ndt/gfy302
M3 - Article
C2 - 30418652
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
SN - 0931-0509
ER -