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A histologic classification of IgA nephropathy for predicting long-term prognosis: emphasis on end-stage renal disease.
Kawamura, Tetsuya; Joh, Kensuke; Okonogi, Hideo; Koike, Kentaro; Utsunomiya, Yasunori; Miyazaki, Yoichi; Matsushima, Masato; Yoshimura, Mitsuhiro; Horikoshi, Satoshi; Suzuki, Yusuke; Furusu, Akira; Yasuda, Takashi; Shirai, Sayuri; Shibata, Takanori; Endoh, Masayuki; Hattori, Motoshi; Katafuchi, Ritsuko; Hashiguchi, Akinori; Kimura, Kenjiro; Matsuo, Seiichi; Tomino, Yasuhiko.
Afiliación
  • Kawamura T; Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. kawatetu@coral.ocn.ne.jp
J Nephrol ; 26(2): 350-7, 2013.
Article en En | MEDLINE | ID: mdl-22684645
BACKGROUND: A multicenter case-control study on IgA nephropathy (IgAN) was conducted to develop an evidence-based clinicopathologic classification of IgAN for predicting long-term renal outcome. METHODS: Two hundred and eighty-seven patients including those with isolated hematuria or very mild proteinuria were enrolled. During a median follow-up of 9.3 years after biopsy, 49 patients (17%) progressed to end stage renal disease (ESRD). The associations between pathological variables and the need for chronic dialysis was examined by multivariate logistic regression analysis separately in patients who required dialysis earlier than 5 years (Early Progressors) and those who required dialysis within 5 to 10 years (Late Progressors) after biopsy. RESULTS: Independent pathological variables predicting progression to ESRD were global sclerosis, segmental sclerosis and fibrous crescents for Early Progressors, and global sclerosis and cellular/fibrocellular crescents for Late Progressors. Four histological grades, HG 1, HG 2, HG 3 and HG 4, were established corresponding to <25%, 25-49%, 50-74% and =75% of glomeruli exhibiting cellular or fibrocellular crescents, global sclerosis, segmental sclerosis or fibrous crescents. Eleven (7%) patients in HG 1, 12 (16%) in HG 2, 13 (31%) in HG 3 and 13 (68%) in HG 4 progressed to ESRD. Multivariate logistic analysis revealed that the risk of progression to ESRD was significantly higher in HG 2, 3 and 4 than in HG 1 (odds ratio, 2.4, 5.7 and 27.6 vs. 1.0). CONCLUSIONS: Our evidence-based histologic classification can identify the magnitude of the risk of progression to ESRD and is useful for predicting long-term renal outcome in IgAN.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glomeruloesclerosis Focal y Segmentaria / Glomerulonefritis por IGA / Fallo Renal Crónico / Glomérulos Renales Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Asia Idioma: En Revista: J Nephrol Asunto de la revista: NEFROLOGIA Año: 2013 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Italia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glomeruloesclerosis Focal y Segmentaria / Glomerulonefritis por IGA / Fallo Renal Crónico / Glomérulos Renales Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Asia Idioma: En Revista: J Nephrol Asunto de la revista: NEFROLOGIA Año: 2013 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Italia