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Review
. 2019 Jan;23(1):16-25.
doi: 10.1007/s10157-018-1657-0. Epub 2018 Oct 26.

A grading system that predicts the risk of dialysis induction in IgA nephropathy patients based on the combination of the clinical and histological severity

Hideo Okonogi  1 , Tetsuya Kawamura  2 , Kensuke Joh  3 , Kentaro Koike  1 , Yoichi Miyazaki  1 , Makoto Ogura  1 , Nobuo Tsuboi  1 , Keita Hirano  1 , Masato Matsushima  4 , Takashi Yokoo  1 , Satoshi Horikoshi  5 , Yusuke Suzuki  5 , Takashi Yasuda  6 , Sayuri Shirai  7 , Takanori Shibata  8 , Motoshi Hattori  9 , Yuko Akioka  9 , Ritsuko Katafuchi  10 , Akinori Hashiguchi  11 , Satoshi Hisano  12 , Akira Shimizu  13 , Kenjiro Kimura  7 , Shoichi Maruyama  14 , Seiichi Matsuo  14 , Yasuhiko Tomino  5 ; Special IgA Nephropathy Study Group
Affiliations
Review

A grading system that predicts the risk of dialysis induction in IgA nephropathy patients based on the combination of the clinical and histological severity

Hideo Okonogi et al. Clin Exp Nephrol. 2019 Jan.

Abstract

Histological classification is essential in the clinical management of immunoglobulin A nephropathy (IgAN). However, there are limitations in predicting the prognosis of IgAN based on histological information alone, which suggests the need for better prognostic models. Therefore, we defined a prognostic model by combining the grade of clinical severity with the histological grading system by the following processes. We included 270 patients and explored the clinical variables associated with progression to end-stage renal disease (ESRD). Then, we created a predictive clinical grading system and defined the risk grades for dialysis induction by a combination of the clinical grade (CG) and the histological grade (HG). A logistic regression analysis revealed that the 24-h urinary protein excretion (UPE) and the estimated glomerular filtration rate (eGFR) were significant independent variables. We selected UPE of 0.5 g/day and eGFR of 60 ml/min/1.73 m2 as the threshold values for the classification of CG. The risk of progression to ESRD of patients with CG II and III was significantly higher than that of patients with CG I. The patients were then re-classified into nine compartments based on the combination of CG and HG. Furthermore, the nine compartments were grouped into four risk groups. The risk of ESRD in the moderate, high, and super-high-risk groups was significantly higher than that in the low-risk group. Herein, we are giving a detailed description of our grading system for IgA nephropathy that predicted the risk of dialysis based on the combination of CG and HG.

Keywords: Clinical classification; Histological classification; IgA nephropathy; Receiver-operating characteristic analysis; Renal biopsy.

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Conflict of interest statement

Ethical standards

All procedures performed in analysis involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted [IRB approval number 16–173 (4401); Jikei University School of Medicine] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors have declared that no conflict of interest exists. Concerning informed consent, we provided the patients with the opportunity to opt out by displaying an outline of the analysis.

Informed consent

Concerning informed consent, we provided the patients with the opportunity to opt out by displaying an outline of the analysis.

Figures

Fig. 1
Fig. 1
Process of constructing the grading system that predicts the risk of dialysis induction in IgA nephropathy patients. The inclusion criteria, steps of constructing histological classification, clinical classification, and grading system are shown
See this image and copyright information in PMC

References

    1. Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Disease. Am J Kidney Dis. 1997;29:526–532. doi: 10.1016/S0272-6386(97)90333-4. - DOI - PubMed
    1. D’Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol. 2004;24:179–196. doi: 10.1016/j.semnephrol.2004.01.001. - DOI - PubMed
    1. Roufosse CA, Cook HT. Pathological predictors of prognosis in immunoglobulin A nephropathy: a review. Curr Opin Nephrol Hypretens. 2009;18:212–219. doi: 10.1097/MNH.0b013e328329605c. - DOI - PubMed
    1. D’Amico G. Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors. Am J Kidney Dis. 2000;36:227–237. doi: 10.1053/ajkd.2000.8966. - DOI - PubMed
    1. Lv J, Shi S, Xu D, et al. Evaluation of the Oxford classification of IgA nephropathy: a systematic review and meta-analysis. Am J Kidney Dis. 2013;62:891–899. doi: 10.1053/j.ajkd.2013.04.021. - DOI - PubMed