Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update
Author:
Coppo Rosanna1, D'Arrigo Graziella2, Tripepi Giovanni2, Russo Maria Luisa1, Roberts Ian S D3, Bellur Shubha3, Cattran Daniel4, Cook Terence H5, Feehally John6, Tesar Vladimir7, Maixnerova Dita7, Peruzzi Licia8, Amore Alessandro8, Lundberg Sigrid9, Di Palma Anna Maria10, Gesualdo Loreto10, Emma Francesco11, Rollino Cristiana12, Praga Manuel13, Biancone Luigi14, Pani Antonello15, Feriozzi Sandro16, Polci Rosaria16, Barratt Jonathan6, Del Vecchio Lucia17, Locatelli Francesco17, Pierucci Alessandro18, Caliskan Yasar19, Perkowska-Ptasinska Agnieszka20, Durlik Magdalena20, Moggia Elisabetta21, Ballarin José C22, Wetzels Jack F M23, Goumenos Dimitris24, Papasotiriou Marios24, Galesic Kresimir25, Toric Luka25, Papagianni Aikaterini26, Stangou Maria26, Benozzi Luisa27, Cusinato Stefano27, Berg Ulla28, Topaloglu Rezan29, Maggio Milena30, Ots-Rosenberg Mai31, D’Amico Marco32, Geddes Colin33ORCID, Balafa Olga34, Quaglia Marco35, Cravero Raffaella36, Lino Cirami Calogero37, Fellstrom Bengt38, Floege Jürgen39, Egido Jesus40, Mallamaci Francesca2, Zoccali Carmine2, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, Coppo R, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, Feehally J, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels J F M, Peters H, Berg U, Carvalho F, da Costa Ferreira A C, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Papastirou M, Galesic K, Toric L, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Rauen T, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders M E J, Boria Grinyo J M, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Roszkowska-Blaim M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma A M, Ferrario F, Gutiérrez E, Asunis A M, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, GalesicLjubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene H J, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E,
Affiliation:
1. Fondazione Ricerca Molinette, Turin, Piemonte, Italy 2. CNR-IFC, Epidemiology, Reggio Calabria, Italy 3. Cellular Pathology, Oxford University Hospital, Oxford, UK 4. University, Toronto GH, Toronto, ON, Canada 5. Department of Nephrology, Imperial College, London, UK 6. Department of Nephrology, Leicester General Hospital, Leicester, UK 7. Nephrology, General University Hospital, Prague, Czech Republic 8. Nephrology, Regina Margherita Hospital, Turin, Italy 9. Department of Nephrology, Karolinska Institutet, Stockholm, Sweden 10. Department of Nephrology, BFU, Bari, Italy 11. Department of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy 12. Department of Nephrology and Dialysis, OSGB, Turin, Italy 13. Department of Nephrology, H12Octubre, Madrid, Spain 14. Department of Nephrology, CSST, Turin, Italy 15. Department of Nephrology, AOGB, Cagliari, Italy 16. Department of Nephrology, Belcolle Hospital, Viterbo, Italy 17. Department of Nephrology, OAM, Lecco, Italy 18. Department of Nephrology, Sapienza University, Rome, Italy 19. Nephrology, Istanbul University, Istanbul, Turkey 20. Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland 21. Department of Nephrology, Santa Croce Hospital, Cuneo, Italy 22. Department of Nephrology, Puigvert, Barcelona, Spain 23. Department of Nephrology and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands 24. Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece 25. Department of Nephrology, Dubrava University, Zagreb, Croatia 26. Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece 27. Department of Nephrology, Borgomanero, Italy 28. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Huddinge, Sweden 29. Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine Ankara, Turkey 30. Department of Nephrology, Hospital Maggiore di Lodi, Lodi, Italy 31. Department of Nephrology, Tartu University Clinics, Tartu, Estonia 32. Nephrology, S. Anna Hospital, Como, Colorado, Italy 33. Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK 34. Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece 35. Department of Nephrology, Maggiore della Carità Hospital, Piem, Onte Orientale University, Novara, Italy 36. Nephrology, Degli Infermi Hospital, Biella, Italy 37. Department of Nephrology, Careggi Hospital, Florence, Italy 38. Renal Department, University of Uppsala, Uppsala, Sweden 39. Division of Nephrology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany 40. Department of Nephrology, Fundacion Jimenez Diaz, CIBERDEM, Madrid, Spain
Abstract
Abstract
Background
It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.
Methods
In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].
Results
In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).
Conclusion
Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
Funder
European Renal Association–European Dialysis and Transplant Association
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
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