TY - JOUR
T1 - Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis
AU - Barbour, Sean J.
AU - Coppo, Rosanna
AU - Er, Lee
AU - Pillebout, Evangeline
AU - Russo, Maria Luisa
AU - Alpers, Charles E.
AU - Fogo, Agnes B.
AU - Ferrario, Franco
AU - Jennette, J. Charles
AU - Roberts, Ian S.D.
AU - Cook, H. Terence
AU - Ding, Jie
AU - Su, Baige
AU - Zhong, Xuhui
AU - Fervenza, Fernando C.
AU - Zand, Ladan
AU - Peruzzi, Licia
AU - Lucchetti, Laura
AU - Katafuchi, Ritsuko
AU - Shima, Yuko
AU - Yoshikawa, Norishige
AU - Ichikawa, Daisuke
AU - Suzuki, Yusuke
AU - Murer, Luisa
AU - Wyatt, Robert J.
AU - Park, Catherine
AU - Nelson, Raoul D.
AU - Narus, Joann H.
AU - Wenderfer, Scott
AU - Geetha, Duvuru
AU - Daugas, Eric
AU - Monteiro, Renato C.
AU - Nakatani, Shinya
AU - Mastrangelo, Antonio
AU - Nuutinen, Matti
AU - Koskela, Mikael
AU - Weber, Lutz T.
AU - Hackl, Agnes
AU - Pohl, Martin
AU - Pecoraro, Carmine
AU - Tsuboi, Nobuo
AU - Yokoo, Takashi
AU - Takafumi, Ito
AU - Fujimoto, Shouichi
AU - Conti, Giovanni
AU - Santoro, Domenico
AU - Materassi, Marco
AU - Zhang, Hong
AU - Shi, Sufang
AU - Bajema, Ingeborg
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - BackgroundNephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts.MethodsBiopsies from 262 children and 99 adults with IgA vasculitis nephritis (N=361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients (N=309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression.ResultsM, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N=91) and another with stable eGFR (class 2, N=218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2.ConclusionsKidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
AB - BackgroundNephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts.MethodsBiopsies from 262 children and 99 adults with IgA vasculitis nephritis (N=361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients (N=309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression.ResultsM, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N=91) and another with stable eGFR (class 2, N=218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2.ConclusionsKidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
KW - GN
KW - Henoch-Schonlein purpura (IgA vasculitis)
KW - kidney biopsy
UR - http://www.scopus.com/inward/record.url?scp=85188503767&partnerID=8YFLogxK
U2 - 10.2215/CJN.0000000000000398
DO - 10.2215/CJN.0000000000000398
M3 - Article
C2 - 38261310
AN - SCOPUS:85188503767
SN - 1555-9041
VL - 19
SP - 438
EP - 451
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 4
ER -