scholarly journals Utilizing the MEST score for prognostic staging in IgA nephropathy

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Yngvar Lunde Haaskjold ◽  
Rune Bjørneklett ◽  
Leif Bostad ◽  
Lars Sigurd Bostad ◽  
Njål Gjærde Lura ◽  
...  

Abstract Background The Oxford classification/MEST score is an established histopathologic scoring system for patients with IgA nephropathy (IgAN). The objective of this study was to derive a prognostic model for IgAN based on the MEST score and histopathologic features. Methods A total of 306 patients with biopsy-proven primary IgAN were included. Histopathologic samples were retrieved from the Norwegian Kidney Biopsy Registry and reclassified according to the Oxford classification. The study endpoint was end-stage renal disease (ESRD). Patients were subclassified into three risk models based on histologic features (Model A), a composite score calculated from the adjusted hazard ratio values (Model B), and on quartiles (Model C). Results The mean follow-up time was 16.5 years (range 0.2–28.1). In total, 61 (20%) patients reached ESRD during the study period. Univariate analysis of M, E, S, T and C lesions demonstrated that all types were associated with an increased risk of ESRD; however, a multivariate analysis revealed that only S, T and C lesions were associated with poor outcomes. Statistical analysis of 15-year data demonstrated that Models A and B were as predictive as the MEST score, with an area-under-the-curve at 0.85. The Harrel c index values were 0.81 and 0.80 for the MEST score and Models A and B, respectively. In the present cohort, adding C lesions to the MEST score did not improve the models prognostic value. Conclusions Patients can be divided into risk classes based on their MEST scores. Histopathologic data provide valuable prognostic information at the time of diagnosis. Model B was the most suitable for clinical practice because it was the most user-friendly.

2020 ◽  
Author(s):  
Heyan Wu ◽  
Zhengkun Xia ◽  
Chunlin Gao ◽  
Pei Zhang ◽  
Xiao Yang ◽  
...  

Abstract Background: The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with IgA nephropathy, but it lacks large cohort validation in children with IgAN in China. We sought to verify that the MEST-C score can be used to predict the renal outcome of children with IgAN. Methods : A retrospective cohort analysis of data from 1243 Chinese children with IgAN who underwent renal biopsy in Jinling Hospital from January 2000 to December 2017.We studied the relationship between the Oxford Classification and renal outcome [a combined renal endpoint:50% estimated glomerular filtration rate (eGFR) loss or end-stage renal disease (ESRD)]. Results :There were 29% of patients with mesangial proliferation (M1), 35% with endocapillary proliferation (E1),37% with segmental sclerosis/adhesion lesion (S1), 23% with moderate tubulointerstitial fibrosis (T1 26-50% of cortex scarred),4.3% with severe tubulointerstitial fibrosis (T2, >50% of cortex scarred),44% with crescent in< 25% of glomeruli(C1), and 4.6% with crescent in>25% of glomeruli(C2).During a median follow-up duration of 86.8 months,171children (14%) developed ESRD or 50% decline in renal function. An early diagnosis seems to be the major reason for a low frequency of chronic and severe lesions such as S,T and C lesions.In the multivariate Cox regression model, Only S( HR 2.7,95% CI ,1.8~4.2, P <0.001) and T lesions ( HR 6.6,95% CI ,3.9~11.3, P <0.001) were associated with the rate of eGFR loss in the whole cohort, whereas C lesion showed this association only in patients not treated with immunosuppression. Conclusions We found that S and T lesions were valid in predicting a renal outcome in Chinese IgAN Children.


2011 ◽  
Vol 34 (5) ◽  
pp. 435-444 ◽  
Author(s):  
Timothy Yau ◽  
Stephen M. Korbet ◽  
Melvin M. Schwartz ◽  
David J. Cimbaluk

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoei Miyabe ◽  
Kazunori Karasawa ◽  
Kenichi Akiyama ◽  
Shota Ogura ◽  
Tomo Takabe ◽  
...  

AbstractThe Oxford classification of IgA nephropathy (IgAN) can evaluate each MEST-C score individually. We analysed a new grading system that utilised the total MEST-C score in predicting renal prognosis. Altogether, 871 IgAN patients were classified into three groups using the new Oxford classification system (O-grade) that utilised the total MEST-C score (O-grade I: 0–1, II: 2–4, and III: 5–7 points), and the 10-year renal prognosis was analysed. The clinical findings became significantly severer with increasing O-grades, and the renal survival rate by the Kaplan–Meier method was 94.1%, 86.9%, and 74.1% for O-grades I, II, and III, respectively. The hazard ratios (HRs) for O-grades II and III with reference to O-grade I were 2.8 (95% confidence interval [CI] 1.3–6.0) and 6.3 (95% CI 2.7–14.5), respectively. In the multivariate analysis, mean arterial pressure and eGFR, proteinuria at the time of biopsy, treatment of corticosteroids/immunosuppressors, and O-grade (HR 1.63; 95% CI 1.11–2.38) were the independent factors predicting renal prognosis. Among the nine groups classified using the O-grade and Japanese clinical-grade, the renal prognosis had an HR of 15.2 (95% CI 3.5–67) in the severest group. The O-grade classified by the total score of the Oxford classification was associated with renal prognosis.


2009 ◽  
Vol 76 (11) ◽  
pp. 1207 ◽  
Author(s):  
Gary S. Hill ◽  
Dominique Nochy ◽  
Khalil El Karoui

2002 ◽  
Vol 13 (2) ◽  
pp. 453-460
Author(s):  
Francesco Paolo Schena ◽  
Giuseppina Cerullo ◽  
Michele Rossini ◽  
Salvatore Giovanni Lanzilotta ◽  
Christian D’Altri ◽  
...  

ABSTRACT. Primary IgA nephropathy (IgAN) is characterized by recurrent episodes of macroscopic hematuria accompanied by upper respiratory tract infections or persistent asymptomatic microscopic hematuria with or without proteinuria. IgAN may involve one or more members of a family. Three generations of a cohort of 110 patients with biopsy-proven IgAN, living in Southern Italy, were checked for urinalysis, and the relative risk (RR) of developing the disease was evaluated. A total of 19 unrelated familial, 37 suspected, and 54 sporadic cases of IgAN were identified. Renal survival was estimated by the Kaplan-Meier method for censored data and compared by use of the log-rank test. More than 50% of the patients with IgAN clustered in kindred with more than two probably affected relatives. In 19 unrelated IgAN families, 8 had single-generation (SG) and 11 multigenerational (MG) involvement showing a prevalent vertical transmission of the trait. The RR was 16 times higher in first-degree relatives (odds ratio [OR], 16.4; 95% confidence interval [CI], 5.7 to 47.8; P < 0.0001) and >2 times higher, even if NS, in second-degree relatives (OR, 2.4; 95 % CI, 0.7 to 7.9; P = 0.145). The clinical and histologic picture of familial and sporadic IgAN appeared to be similar. The 20-yr renal survival rate from the apparent onset of the disease was significantly poorer in patients with familial (41%) than in patients with sporadic (94%) IgAN (P = 0.003). Furthermore, 15-yr renal survival from the time of renal biopsy was significantly worse in familial IgAN (P = 0.02); end-stage renal disease was present in 64% of familial and only in 8% of patients with sporadic IgAN. Finally, renal survival was significantly worse in patients belonging to families with SG rather than with MG involvement (P = 0.03). These data show, for the first time, that familial IgAN may be considered a nonbenign disease that occurs frequently in first-degree relatives. Familial IgAN has a poorer outcome than sporadic IgAN. Therefore, an accurate family history and urinalysis in all family members is urgently recommended in clinical practice. This procedure might avoid late referral of subjects with persistent and underestimated urinary abnormalities and late diagnosis of the disease.


2021 ◽  
pp. 1-5
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Fabio A. Frisoli ◽  
Megan S. Cadigan ◽  
Jacob F. Baranoski ◽  
...  

OBJECTIVEThe SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.METHODSThe records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups.RESULTSA total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5–4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2–6.2; p < 0.001) follow-ups.CONCLUSIONSHigh SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.


2021 ◽  
Vol 11 (7) ◽  
pp. 1985-1994
Author(s):  
Shanhong Shi ◽  
Fang Xing ◽  
Weiyuan Lin

Objective: This paper focuses on the foot-process in renal biopsies of patients with lgA, and examines their correlation with baseline clinical indicators and pathological manifestations in patients with lgA. Method: A retrospective data of patients who performed renal biopsy proven IgA nephropathy was selected. The patients who reached the agreed standard were grouped based on the degree of foot-process. There were three groups (ABC Groups) (Du, Y. and Huang, C, 2009. The value of proteinuria and foot process fusion in the onset of prognosis of acute kidney disease. Chinese Journal of Integrated Traditional and Western Medicine, 10(1), pp.44-45): group A for patients with no obvious foot-process lesion; group B for patients with segmental foot-process; group C for patients with massive foot-process. The three groups were reviewed in the aspects of baseline clinical indicators and Oxford classification, so as to discover foot-process’ effect on patients with IgA nephropathy. Results: A total of 129 patients with IgA nephropathy were included in the study. Concerning about the clinical baseline indicators related to the degree of foot-process, the 24-hour proteinuria level at admission was statistically significant and positively correlated (r = 0.324, P = 0.000). The comparison between groups showed there was statistically significant difference between group C and group A and group B (P = 0.001, P = 0.035). According to the Oxford Classification, only the differences of mesangial hypercellularity (M) and segmental sclerosis/adhesion (S) were statistically significant (r = 0.239, P = 0.006; r = 0.257, P = 0.003) and were positively correlated. In terms of mesangial hypercellularity (M), the differences between group A and B, group A and C were statistically significant (P = 0.01, P = 0.003). The comparison between group B and group C showed statistical difference (P = −0.031) in segmental sclerosis/adhesion (S). Among the 76 patients with S0 revealed by the Oxford classification, there were 55 patients of glomerulosclerosis, which was positively correlated with the degree of foot process (r = 0.211, P = 0.016). The comparison between group A and group C showed statistical difference (P = 0.014). Conclusion: The severity foot-process was positively correlated with the level of proteinuria. Foot-process is positively related with mesangial hypercellularity, segmental sclerosis and glomerulosclerosis. With more severe the foot-process, there will be more serious mesangial hypercellularity and irreversible glomerular injury. Foot-process is positively correlated with Lee’s Pathological Grading.


2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii456-iii457
Author(s):  
Alastair Rankin ◽  
Bruce Mackinnon ◽  
David Kipgen ◽  
Jonathan Fox ◽  
Colin Geddes ◽  
...  

2020 ◽  
Vol 10 (11) ◽  
pp. 771
Author(s):  
Milena Świtońska ◽  
Natalia Piekuś-Słomka ◽  
Artur Słomka ◽  
Paweł Sokal ◽  
Ewa Żekanowska ◽  
...  

Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting sHT in patients with AIS undergoing revascularization. Methods: Consecutive patients hospitalized for AIS who underwent intravenous thrombolysis, mechanical thrombectomy or both were identified. The NLR values were estimated at admission. The study endpoint was the occurrence of sHT within 24 h from stroke treatment. Results: Fifty-one patients with AIS were included, with a median age of 67 (interquartile range, 55–78) years. sHT occurred in 10 (19.6%) patients. Patients who developed sHT had higher NLR at admission. NLR was an independent predictor of sHT and showed good discriminatory power (area under the curve 0.81). In a multivariable analysis, NLR and systolic blood pressure were independently associated with sHT. Conclusions: NLR at admission can accurately predict sHT in patients with AIS undergoing revascularization.


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