Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy
Many studies have shown that chronic changes are strong predictors of renal outcomes in various kidney diseases, including IgA nephropathy. The Mayo Clinic/Renal Pathology Society suggested a glomerulonephritis reporting system with a proposal for standardized grading of chronic changes. The purpose...
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.952050/full |
| _version_ | 1818495983247425536 |
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| author | Donghyuk Kang Tae Hyun Ban Ho Jun Chin Hajeong Lee Se Won Oh Cheol Whee Park Chul Woo Yang Bum Soon Choi |
| author_facet | Donghyuk Kang Tae Hyun Ban Ho Jun Chin Hajeong Lee Se Won Oh Cheol Whee Park Chul Woo Yang Bum Soon Choi |
| author_sort | Donghyuk Kang |
| collection | DOAJ |
| description | Many studies have shown that chronic changes are strong predictors of renal outcomes in various kidney diseases, including IgA nephropathy. The Mayo Clinic/Renal Pathology Society suggested a glomerulonephritis reporting system with a proposal for standardized grading of chronic changes. The purpose of this study was to predict renal outcomes in patients with IgA nephropathy using chronicity grading in comparison to the Oxford classification which did not include global sclerosis. A total of 4,151 patients with IgA nephropathy were enrolled from the Korean GlomeruloNephritis Study Group registry. Chronicity grading was categorized into minimal, mild, moderate, and severe according to the extent of chronic changes. The Oxford T and S scores were considered as chronic lesions. Three prediction models were constructed: the Oxford classification model (Oxford S plus T), chronicity grading model A (chronicity grading), and chronicity grading model B (chronicity grading plus Oxford S). Using these three prediction models, the primary renal outcome (end-stage renal disease) was evaluated using Cox regression analysis and prediction performance. During the median follow-up of 6.1 (2.7–9.9) years, 304 (7.3%) patients progressed to end-stage renal disease with a cumulative incidence rate of 1.02 events per 100 person-years. In a fully adjusted multivariable model, chronicity grading was independently associated with the primary renal outcome in both models A and B. Compared to the Oxford model, both models A and B showed improvements in model fit, but not in discrimination (ΔC 0.001; 95% CI, −0.010 to 0.013 and ΔC 0.002; 95% CI, −0.005 to 0.008, respectively). Model B demonstrated improvements in integrated discrimination improvement (0.01; 95% CI, 0–0.03) and continuous net reclassification improvement (0.49; 95% CI, 0.02–0.72). The severity of chronicity grading is closely related to adverse renal outcomes in patients with IgA nephropathy, and chronicity grading could provide additional information in clinical practice alongside the Oxford classification. |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-10T18:27:28Z |
| publishDate | 2022-08-01 |
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| spelling | doaj.art-4dc1d0df823e4a4d83ed615054f7ddab2022-12-22T01:38:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-08-01910.3389/fmed.2022.952050952050Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathyDonghyuk Kang0Tae Hyun Ban1Ho Jun Chin2Hajeong Lee3Se Won Oh4Cheol Whee Park5Chul Woo Yang6Bum Soon Choi7Department of Nephrology and Hypertension, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University College of Medicine, Seoul, South KoreaMany studies have shown that chronic changes are strong predictors of renal outcomes in various kidney diseases, including IgA nephropathy. The Mayo Clinic/Renal Pathology Society suggested a glomerulonephritis reporting system with a proposal for standardized grading of chronic changes. The purpose of this study was to predict renal outcomes in patients with IgA nephropathy using chronicity grading in comparison to the Oxford classification which did not include global sclerosis. A total of 4,151 patients with IgA nephropathy were enrolled from the Korean GlomeruloNephritis Study Group registry. Chronicity grading was categorized into minimal, mild, moderate, and severe according to the extent of chronic changes. The Oxford T and S scores were considered as chronic lesions. Three prediction models were constructed: the Oxford classification model (Oxford S plus T), chronicity grading model A (chronicity grading), and chronicity grading model B (chronicity grading plus Oxford S). Using these three prediction models, the primary renal outcome (end-stage renal disease) was evaluated using Cox regression analysis and prediction performance. During the median follow-up of 6.1 (2.7–9.9) years, 304 (7.3%) patients progressed to end-stage renal disease with a cumulative incidence rate of 1.02 events per 100 person-years. In a fully adjusted multivariable model, chronicity grading was independently associated with the primary renal outcome in both models A and B. Compared to the Oxford model, both models A and B showed improvements in model fit, but not in discrimination (ΔC 0.001; 95% CI, −0.010 to 0.013 and ΔC 0.002; 95% CI, −0.005 to 0.008, respectively). Model B demonstrated improvements in integrated discrimination improvement (0.01; 95% CI, 0–0.03) and continuous net reclassification improvement (0.49; 95% CI, 0.02–0.72). The severity of chronicity grading is closely related to adverse renal outcomes in patients with IgA nephropathy, and chronicity grading could provide additional information in clinical practice alongside the Oxford classification.https://www.frontiersin.org/articles/10.3389/fmed.2022.952050/fullIgA nephropathyend-stage renal diseaserenal biopsypathologyglomerulosclerosisinterstitial fibrosis |
| spellingShingle | Donghyuk Kang Tae Hyun Ban Ho Jun Chin Hajeong Lee Se Won Oh Cheol Whee Park Chul Woo Yang Bum Soon Choi Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy Frontiers in Medicine IgA nephropathy end-stage renal disease renal biopsy pathology glomerulosclerosis interstitial fibrosis |
| title | Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
| title_full | Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
| title_fullStr | Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
| title_full_unstemmed | Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
| title_short | Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
| title_sort | prognostic value of chronicity grading on renal outcomes in patients with iga nephropathy |
| topic | IgA nephropathy end-stage renal disease renal biopsy pathology glomerulosclerosis interstitial fibrosis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.952050/full |
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