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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449317/ https://www.ncbi.nlm.nih.gov/pubmed/36091686 http://dx.doi.org/10.3389/fmed.2022.952050 |
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author | Kang, Donghyuk Ban, Tae Hyun Chin, Ho Jun Lee, Hajeong Oh, Se Won Park, Cheol Whee Yang, Chul Woo Choi, Bum Soon |
author_facet | Kang, Donghyuk Ban, Tae Hyun Chin, Ho Jun Lee, Hajeong Oh, Se Won Park, Cheol Whee Yang, Chul Woo Choi, Bum Soon |
author_sort | Kang, Donghyuk |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-9449317 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94493172022-09-08 Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy Kang, Donghyuk Ban, Tae Hyun Chin, Ho Jun Lee, Hajeong Oh, Se Won Park, Cheol Whee Yang, Chul Woo Choi, Bum Soon Front Med (Lausanne) Medicine 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. Frontiers Media S.A. 2022-08-24 /pmc/articles/PMC9449317/ /pubmed/36091686 http://dx.doi.org/10.3389/fmed.2022.952050 Text en Copyright © 2022 Kang, Ban, Chin, Lee, Oh, Park, Yang and Choi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Kang, Donghyuk Ban, Tae Hyun Chin, Ho Jun Lee, Hajeong Oh, Se Won Park, Cheol Whee Yang, Chul Woo Choi, Bum Soon Prognostic value of chronicity grading on renal outcomes in patients with IgA nephropathy |
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 | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449317/ https://www.ncbi.nlm.nih.gov/pubmed/36091686 http://dx.doi.org/10.3389/fmed.2022.952050 |
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