Serriello Ilaria, Polci Rosaria, Feriozzi Sandro, Gigante Antonietta, Di Giulio Salvatore, Rosa Margherita, Galliani Marco, Morosetti Massimo, Pugliese Francesco, Petitti Tommasangelo, Onetti Muda Andrea, Giannakakis Konstantinos
Nephrology and Dialysis Department, Belcolle Hospital, Viterbo, Italy.
Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Nephrology (Carlton). 2015 Sep;20(9):654-9. doi: 10.1111/nep.12497.
Oxford classification of Immunoglobulin A Nephropathy (IgAN) identifies four pathological features as predictors of renal outcome (MEST-score): mesangial proliferation (M); endocapillary proliferation (E); segmental glomerulosclerosis (S); tubular atrophy/interstitial fibrosis (T). In particular extracapillary proliferation (Ex) was not considered as an independent histological variable predicting renal outcome. Recently the VALIGA study provided a validation of the Oxford classification in a large European cohort of IgAN patients and re-stated that Ex is not associated with a worse renal prognosis. We propose a retrospective study to evaluate the predictive value of the MEST-score in a multi-centre, single region group of patients from central Italy and in addition, to investigate Ex as a marker predicting renal outcome.
One hundred and seven patients were enrolled in this study. Clinical data of each patient were available at diagnosis and follow-up. The median age at diagnosis was 36.7 years; 72% of the patients were males. Histological parameters were those included in the MEST-score of the Oxford classification; in addition, Ex was also assessed.
Multiple linear regression models for survey were used. Statistical analysis showed a correlation between the progression of renal decline, in terms of estimated glomerular filtration rate (slope eGFR), and M, S, T. Differently from Oxford and VALIGA studies, no correlation was found with E, while Ex correlated with a decline of eGFR.
Our results suggest that Ex represents an additional independent variable associated with a faster decline of renal function in IgAN.
免疫球蛋白A肾病（IgAN）的牛津分类确定了四种病理特征作为肾脏预后的预测指标（MEST评分）：系膜增生（M）；毛细血管内增生（E）；节段性肾小球硬化（S）；肾小管萎缩/间质纤维化（T）。特别是，毛细血管外增生（Ex）未被视为预测肾脏预后的独立组织学变量。最近，VALIGA研究在一大群欧洲IgAN患者中对牛津分类进行了验证，并再次指出Ex与较差的肾脏预后无关。我们提出一项回顾性研究，以评估MEST评分在意大利中部一个多中心、单区域患者组中的预测价值，此外，研究Ex作为预测肾脏预后的标志物。
本研究纳入了107例患者。每位患者的临床数据在诊断和随访时均可获得。诊断时的中位年龄为36.7岁；72%的患者为男性。组织学参数为牛津分类的MEST评分中包含的参数；此外，还评估了Ex。
使用了用于调查的多元线性回归模型。统计分析显示，就估计肾小球滤过率（斜率eGFR）而言，肾脏功能下降的进展与M、S、T之间存在相关性。与牛津和VALIGA研究不同，未发现与E相关，而Ex与eGFR下降相关。
我们的结果表明，Ex代表了一个与IgAN患者肾功能更快下降相关的额外独立变量。
