Predicting the Risk for Dialysis or Death in IgA Nephropathy

Berthoux, F; Mohey, Hesham; Laurent, B.; Mariat, Christophe; Afiani, Aïda; Thibaudin, Lise

doi:10.1681/asn.2010040355

Cited by 308 publications

(250 citation statements)

References 40 publications

Supporting

Mentioning

236

Contrasting

Unclassified

Order By: Relevance

“…However, the patients in the present study showed only 10% of ESRD, which reflected the relatively "low-risk" features of our cohort compared with other published cohorts. In fact, most of our patients had relatively low-grade proteinuria (,1 g/d) and low-risk pathologic features, and fewer had hypertension and advanced CKD stage than those in previous studies (6,8,17,37). Thus, one should take care in applying the risk scores developed in the present study to a traditionally high-risk population of patients with IgAN.…”

Section: Variables Scoresmentioning

confidence: 77%

“…We believe that this score will be useful for determining the initial therapeutic strategies of patients with IgAN. Several risk scores for developing ESRD in patients with IgAN have been reported previously (2,8,17). However, these studies had several limitations.…”

Section: Variables Scoresmentioning

confidence: 98%

“…Many epidemiologic studies have identified risk factors for poor kidney prognosis in patients with IgAN, including age (2), sex (3), hypertension (3,4), decreased estimated GFR (eGFR) (2)(3)(4)(5), proteinuria (2,3,(6)(7)(8), and pathologic severity (2,9,10). In 2009, the Oxford classification of IgAN was proposed by an international working group (11,12).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, some investigators have attempted to develop a risk prediction rule for estimating the risk of ESRD in individual patients (2,8,17). However, few studies have evaluated the internal or external validity of their risk prediction tools.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Development and Validation of a Prediction Rule Using the Oxford Classification in IgA Nephropathy

Tanaka

Ninomiya

Katafuchi

et al. 2013

Clinical Journal of the American Society of Nephrology

105

View full text Add to dashboard Cite

SummaryBackground and objectives The risk assessment for developing ESRD remains limited in patients with IgA nephropathy (IgAN). The aim of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with IgAN.Design, setting, participants, & measurements A total of 698 patients with IgAN diagnosed by renal biopsy at Kyushu University Hospital (derivation cohort) between 1982 and 2010 were retrospectively followed. The Oxford classification was used to evaluate the pathologic lesions. The risk factors for developing ESRD were evaluated using a Cox proportional hazard model with a stepwise backward elimination method. The prediction rule was verified using data from 702 patients diagnosed at Japanese Red Cross Fukuoka Hospital (validation cohort) between 1979 and 2002.Results In the derivation cohort, 73 patients developed ESRD during the median 4.7-year follow-up. The final prediction model included proteinuria (hazard ratio [HR], 1.30; 95% confidence interval [95% CI], 1.16 to 1.45, every 1 g/24 hours), estimated GFR (HR, 0.84; 95% CI, 0.74 to 0.96, every 10 ml/min per 1.73 m 2 ), mesangial proliferation (HR, 1.85; 95% CI, 1.10 to 3.11), segmental sclerosis (HR, 3.21; 95% CI, 1.37 to 7.51), and interstitial fibrosis/tubular atrophy (T1: HR, 5.30; 95% CI, 2.63 to 10.7; T2: HR, 20.5; 95% CI, 9.05 to 46.5) as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The incidence of ESRD increased linearly with increases in the total risk scores (P for trend ,0.001). Furthermore, the prediction rule demonstrated good discrimination (c-statistic=0.89) and calibration (Hosmer-Lemeshow test, P=0.78) in the validation cohort.Conclusions This study developed and validated a new prediction rule using clinical measures and the Oxford classification for developing ESRD in patients with IgAN.

show abstract

Section: Variables Scoresmentioning

confidence: 77%

Section: Variables Scoresmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development and Validation of a Prediction Rule Using the Oxford Classification in IgA Nephropathy

Tanaka

Ninomiya

Katafuchi

et al. 2013

Clinical Journal of the American Society of Nephrology

105

View full text Add to dashboard Cite

show abstract

“…Proteinuria is regarded as a risk factor for an unfavorable renal prognosis and the reduction of proteinuria is considered an important therapeutic goal in clinical practice (3–5). In addition to proteinuria, active renal lesions, such as cellular crescent formation, diffuse mesangial proliferation and interstitial inflammatory infiltration have been identified to result in a rapid rate of deterioration and lower kidney survival (6).…”

Section: Introductionmentioning

confidence: 99%

Continuation of immunosuppressive treatment may be necessary in IgA nephropathy patients with remission of proteinuria: Evaluation by repeat renal biopsy

Luo

Yao

et al. 2013

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

The present study aimed to evaluate the effects of an individualized, low-dose multi-drug immunosuppressive regimen for the treatment of immunoglobulin A nephropathy (IgAN). A preliminary investigation of the course of IgAN following immunosuppressive treatment was conducted based on repeat renal biopsies. Clinical and pathological data of 17 patients with IgAN who received repeat renal biopsies were analyzed retrospectively. In addition to basic treatment, 16 patients regularly received an individualized low-dose immunosuppressive regimen according to their clinical manifestations and pathological patterns following the first biopsy. Clinical parameters, including 24-h urinary protein excretion and levels of serum albumin, uric acid and total cholesterol were collected. Glomerular deposits of IgA and C3, as well as the activity and chronicity indexes of renal lesions were evaluated by semi-quantitative methods. The 24-h urinary protein excretion of the patients decreased significantly from the first biopsy (2.53±2.17 g/day) to the repeated biopsy (0.26±0.55 g/day) (P<0.001). Deposits of IgA and C3 in the glomerulus were persistent, but were reduced in quantity at the second biopsy. Although active renal lesions were observed in the majority of patients, the activity index decreased significantly from 3.18±1.33 prior to therapy to 2.47±0.80 following therapy (P<0.05), while the chronicity index did not change significantly (2.59±2.00 versus 2.76±1.89, respectively). The individualized, low-dose multi-drug immunosuppressive regimen used in the present study significantly minimized proteinuria, stabilized renal function and alleviated histological lesions in patients with IgAN without causing overt adverse effects during the short-term follow-up. In addition to proteinuria, renal pathological changes should be appraised when considering the withdrawal of immunosuppressants from IgAN treatment.

show abstract

Evaluating a New International Risk-Prediction Tool in IgA Nephropathy

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Although IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, there is no validated tool to predict disease progression. This limits patient-specific risk stratification and treatment decisions, clinical trial recruitment, and biomarker validation. OBJECTIVE To derive and externally validate a prediction model for disease progression in IgAN that can be applied at the time of kidney biopsy in multiple ethnic groups worldwide. DESIGN, SETTING, AND PARTICIPANTS We derived and externally validated a prediction model using clinical and histologic risk factors that are readily available in clinical practice. Large, multi-ethnic cohorts of adults with biopsy-proven IgAN were included from Europe, North America, China, and Japan. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to analyze the risk of a 50% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease, and were evaluated using the R 2 D measure, Akaike information criterion (AIC), C statistic, continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI), and calibration plots. RESULTS The study included 3927 patients; mean age, 35.4 (interquartile range, 28.0-45.4) years; and 2173 (55.3%) were men. The following prediction models were created in a derivation cohort of 2781 patients: a clinical model that included eGFR, blood pressure, and proteinuria at biopsy; and 2 full models that also contained the MEST histologic score, age, medication use, and either racial/ethnic characteristics (white, Japanese, or Chinese) or no racial/ethnic characteristics, to allow application in other ethnic groups. Compared with the clinical model, the full models with and without race/ethnicity had better R 2 D (26.3% and 25.3%, respectively, vs 20.3%) and AIC (6338 and 6379, respectively, vs 6485), significant increases in C statistic from 0.78 to 0.82 and 0.81, respectively (ΔC, 0.04; 95% CI, 0.03-0.04 and ΔC, 0.03; 95% CI, 0.02-0.03, respectively), and significant improvement in reclassification as assessed by the NRI (0.18; 95% CI, 0.07-0.29 and 0.51; 95% CI, 0.39-0.62, respectively) and IDI (0.07; 95% CI, 0.06-0.08 and 0.06; 95% CI, 0.05-0.06, respectively). External validation was performed in a cohort of 1146 patients. For both full models, the C statistics (0.82; 95% CI, 0.81-0.83 with race/ethnicity; 0.81; 95% CI, 0.80-0.82 without race/ethnicity) and R 2 D (both 35.3%) were similar or better than in the validation cohort, with excellent calibration. CONCLUSIONS AND RELEVANCE In this study, the 2 full prediction models were shown to be accurate and validated methods for predicting disease progression and patient risk stratification in IgAN in multi-ethnic cohorts, with additional applications to clinical trial design and biomarker research.

show abstract

Predicting the Risk for Dialysis or Death in IgA Nephropathy

Cited by 308 publications

References 40 publications

Development and Validation of a Prediction Rule Using the Oxford Classification in IgA Nephropathy

Development and Validation of a Prediction Rule Using the Oxford Classification in IgA Nephropathy

Continuation of immunosuppressive treatment may be necessary in IgA nephropathy patients with remission of proteinuria: Evaluation by repeat renal biopsy

Evaluating a New International Risk-Prediction Tool in IgA Nephropathy

Contact Info

Product

Resources

About