Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis-Reference-Cited by-全球学者库

Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis

Published:2024-01-23 Issue: Volume: Page:
ISSN:1555-9041
Container-title:Clinical Journal of the American Society of Nephrology
language:en
Short-container-title:CJASN

Author:

Barbour Sean J.¹²,Coppo Rosanna³^ORCID,Er Lee²,Pillebout Evangeline⁴^ORCID,Russo Maria Luisa³,Alpers Charles E.⁵^ORCID,Fogo Agnes B.⁶,Ferrario Franco⁷,Jennette J. Charles⁸⁹^ORCID,Roberts Ian S.D.¹⁰,Cook H. Terence¹¹,Ding Jie¹²^ORCID,Su Baige¹²,Zhong Xuhui¹²,Fervenza Fernando C.¹³^ORCID,Zand Ladan¹³^ORCID,Peruzzi Licia¹⁴^ORCID,Lucchetti Laura¹⁵^ORCID,Katafuchi Ritsuko¹⁶,Shima Yuko¹⁷^ORCID,Yoshikawa Norishige¹⁸,Ichikawa Daisuke¹⁹^ORCID,Suzuki Yusuke²⁰^ORCID,Murer Luisa²¹,Wyatt Robert J.²²,Nelson Raoul D.²³,Narus JoAnn H.²⁴^ORCID,Wenderfer Scott²⁵^ORCID,Geetha Duvuru²⁶^ORCID,Daugas Eric²⁷^ORCID,Monteiro Renato C.²⁸^ORCID,Nakatani Shinya²⁹,Mastrangelo Antonio³⁰,Nuutinen Matti³¹,Koskela Mikael³²,Weber Lutz T³³^ORCID,Hackl Agnes³³,Pohl Martin³⁴,Pecoraro Carmine³⁵,Tsuboi Nobuo³⁶^ORCID,Yokoo Takashi³⁵^ORCID,Takafumi Ito³⁶,Fujimoto Shouichi³⁵^ORCID,Conti Giovanni³⁶^ORCID,Santoro Domenico³⁷,Materassi Marco³⁸^ORCID,Zhang Hong³⁹,Shi Sufang⁴⁰^ORCID,Liu Zhi-Hong⁴¹^ORCID,Tesar Vladimir⁴²^ORCID,Maixnerova Dita⁴³^ORCID,Avila-Casado Carmen⁴⁴,Bajema Ingeborg⁴⁵,Barreca Antonella⁴⁶^ORCID,Becker Jan U.⁴⁷,Comstock Jessica M.⁴⁸,Cornea Virgilius⁴⁹^ORCID,Eldin Karen⁵⁰^ORCID,Hernandez Loren Herrera⁵¹,Hou Jean⁵²,Joh Kensuke⁵³^ORCID,Lin Mercury⁵²,Messias Nidia⁵⁴,Muda Andrea Onetti⁵⁵^ORCID,Pagni Fabio⁷^ORCID,Diomedi-Camassei Francesca⁵⁶^ORCID,Tokola Heikki⁵⁷^ORCID,D’Armiento Maria⁵⁸,Seidl Maximilian⁵⁹^ORCID,Rosenberg Avi⁶⁰^ORCID,Sannier Aurélie⁶¹^ORCID,Soares Maria Fernanda¹⁰^ORCID,Wang Suxia⁶²^ORCID,Zeng Caihong⁴¹^ORCID,Haas Mark⁵²

Affiliation:

1. University of British Columbia, Division of Nephrology, Vancouver, Canada

2. BC Renal, Vancouver, Canada

3. Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy

4. Nephrology Unit, Saint Louis Hospital, Paris, France

5. Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA USA

6. Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

7. Department of Medicine and Surgery, University Milan Bicocca, IRCCS San Gerardo, Monza, Italy

8. Department of Pathology and Laboratory Medicine, University of North Carolina

9. School of Medicine, Chapel Hill, NC USA

10. Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, UK

11. Imperial College London, London, UK

12. Department of Pediatrics, Peking University First Hospital, Beijing, China

13. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA

14. Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, AOU Città della Salute della Scienza di Torino, Italy

15. Division of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy

16. Kidney Unit, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan

17. Department of Pediatrics, Wakayama Medical University, Wakayama, Japan

18. Clinical Research Center, Takatsuki General Hospital; Wakayam Medical University, Takatsuki City, Japan

19. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan

20. Department of Nephrology, Juntendo University Faculty of Medicine

21. Department of Women’s and Child’s Health, Pediatric Nephrology Dialysis and Transplant Unit, Azienda Ospedaliera-University of Padova, Padova Italy

22. Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA

23. Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA

24. Pediatrics Clinical Trials Office, University of Utah, Salt Lake City, Utah, USA

25. University of British Columbia, Division of Pediatric Nephrology, Vancouver, Canada; Texas Children’s Hospital, Houston, USA

26. Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

27. Nephrology, Bichat Hospital, AP-HP, Paris France; INSERM U1149 and Université Paris Cité

28. Bichat Hospital, Centre for Research on Inflammation, Inserm & Université Paris Cité, Paris, France

29. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

30. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCC Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy

31. Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu)

32. Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

33. Pediatric Nephrology, Children’s and Adolescents’ Hospital, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

34. Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

35. Department of Nephrology / Division of Dialysis, University of Miyazaki Hospital, Miyazaki, Japan

36. Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, University of Messina

37. University of Messina; Nephrology and Dialysis Unit AOU, G. Martino, Messina, Italy

38. Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy

39. Renal Division, Peking University First Hospital

40. Kidney Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology

41. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

42. Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic

43. Department of Nephrology, General University Hospital, 1st Faculty of Medicine, Prague, Czech Republic

44. Department of Pathology, University of Toronto, Toronto, ON, Canada

45. Department of Pathology and Medical Biology, University of Groningen, Groningen, Netherlands

46. Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Via Santena 7, 10126 Turin, Italy

47. Institute of Pathology, University Hospital of Cologne, Cologne, Germany

48. Department of Pathology, University of Utah, Salt Lake City, Utah, USA

49. Department of Pathology, University of Kentucky Medical Center, Lexington, KY, USA

50. Department of Pathology, Mass General Brigham, Salem Hospital, Salem, Massachusetts, USA

51. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

52. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

53. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

54. Department of Pathology, Washington University in Saint Louis, St. Louis, MO, USA

55. Bambino Gesù Children's Hospital – IRCCS, Rome, Italy

56. Pathology Department, Bambino Gesù Children’s Hospital, Rome, Italy

57. Pathology, University Oulu and Oulu University Hospital, Finland

58. Department of Public Health, Pathology Section, School of Medicine, University of Naples Federico II, Naples, Italy

59. Institute for Surgical Pathology, Medical Center- University of Freiburg and Faculty of Medicine, University of Freiburg, Freiburg, Germany

60. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

61. Department of Pathology, AP-HP, hôpital Bichat, Paris, France, université Paris Cité

62. Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China

Abstract

Background: Nephritis 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. Methods: Biopsies 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 3 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 (LCMM) to identify classes of eGFR trajectories over a median follow-up of 2.7 years (IQR 1.2, 5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. Results: M, E, T and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by LCMM, 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, HR 5.84, 95%CI 2.37, 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, male sex, lower eGFR at biopsy, and extrarenal non-cutaneous disease. Fibrous crescents without active changes were associated with Class 2. Conclusions: Kidney 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 ISKDC classification..

Funder

Cedars-Sinai Medical Center

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation,Nephrology,Critical Care and Intensive Care Medicine,Epidemiology