A histologic classification of IgA nephropathy for predicting long-term prognosis: Emphasis on end-stage renal disease

Tetsuya Kawamura, Kensuke Joh, Hideo Okonogi, Kentaro Koike, Yasunori Utsunomiya, Yoichi Miyazaki, Masato Matsushima, Mitsuhiro Yoshimura, Satoshi Horikoshi, Yusuke Suzuki, Akira Furusu, Takashi Yasuda, Sayuri Shirai, Takanori Shibata, Masayuki Endoh, Motoshi Hattori, Yuko Akioka, Ritsuko Katafuchi, Akinori Hashiguchi, Kenjiro KimuraSeiichi Matsuo, Yasuhiko Tomino

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Abstract

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 longterm renal outcome in IgAN.

Original languageEnglish
Pages (from-to)350-357
Number of pages8
JournalJournal of Nephrology
Volume26
Issue number2
DOIs
Publication statusPublished - 2013

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Keywords

  • End-stage renal disease
  • IgA nephropathy
  • Prognosis
  • Progression
  • Risk factor

ASJC Scopus subject areas

  • Nephrology

Cite this

Kawamura, T., Joh, K., Okonogi, H., Koike, K., Utsunomiya, Y., Miyazaki, Y., Matsushima, M., Yoshimura, M., Horikoshi, S., Suzuki, Y., Furusu, A., Yasuda, T., Shirai, S., Shibata, T., Endoh, M., Hattori, M., Akioka, Y., Katafuchi, R., Hashiguchi, A., ... Tomino, Y. (2013). A histologic classification of IgA nephropathy for predicting long-term prognosis: Emphasis on end-stage renal disease. Journal of Nephrology, 26(2), 350-357. https://doi.org/10.5301/jn.5000151