The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.

Barbour, S., Espino Hernandez, G., Reich, H., Coppo, R., Roberts, I., Feehally, J., et al. (2015). The MEST score provides earlier risk prediction in IgA nephropathy. KIDNEY INTERNATIONAL, 89(1), 167-175 [10.1038/ki.2015.322].

The MEST score provides earlier risk prediction in IgA nephropathy

Morosetti, M
2015

Abstract

The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/14 - Nefrologia
English
IgA nephropathy; glomerular disease; renal pathology
Barbour, S., Espino Hernandez, G., Reich, H., Coppo, R., Roberts, I., Feehally, J., et al. (2015). The MEST score provides earlier risk prediction in IgA nephropathy. KIDNEY INTERNATIONAL, 89(1), 167-175 [10.1038/ki.2015.322].
Barbour, S; Espino-Hernandez, G; Reich, H; Coppo, R; Roberts, I; Feehally, J; Herzenberg, A; Cattran, D; Oxford Derivation North American Validation and VALIGA, C; Morosetti, M
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2108/140540
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