Martín-Penagos Luis, Benito Adalberto, Oviedo María Victoria, López Del Moral Cuesta Covadonga, Martín López Javier, Gómez Román Javier, López-Mejías Raquel, Fernandez-Fresnedo Gema, Ruíz San Millán Juan Carlos, Rodrigo Calabia Emilio
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Cantabria, España.
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Cantabria, España.
Nefrologia (Engl Ed). 2019 Sep-Oct;39(5):523-530. doi: 10.1016/j.nefro.2018.10.015. Epub 2019 Mar 20.
IgA nephropathy (IgAN) is the most common and heterogeneous glomerular nephropathy. Several strategies have been used to determine the risk of progression to ESRD. We evaluate the prognostic significance and correlate the IgAN progression calculator (IgANPC) and the Oxford/MEST-C score in our population.
We performed a retrospective study of biopsied patients with diagnosis of IgA nephropathy from 1990 to 2015. We classified the biopsies using MEST-C score and we correlated the score to clinical evolution. We also calculated the risk of progression with the online IgANPC at the time of the biopsy.
We analysed 48 biopsies, 83% of which were men with a mean age of 45 years at the time of the biopsy. Patients with a biopsy E1 according to MEST-C score had a higher IgANPC score than those with E0 (P=.021). The Pearson's correlation for the percentage of crescents and the IgANPC risk score was statistically significant (P=.014) with r=0.357. The percentage of patients with eGFR above 30 ml/min at 10 years was 100% for the low-risk group (group 1 of IgANPC), and 0% for the high-risk group (group 3), log rank P=0.001. The log rank comparison for variables of the MEST-C score, presented statistically significant results between E (0.036) and S (0.022) and the eGFR time<30 ml/min. A statistically significant relationship was also observed between T1 and eGFR<30 ml/min. The multivariate Cox regression analysis for IgANPC and eGFR<30 ml/min demonstrated a strong correlation (P=.016) between the risk group and eGFR <30 ml/min.
In our study population, the IgANPC predicts the time to eGFR<30 ml/min, and adds information independent of the MEST. The MEST-C classification and IgANPC are useful and independent ÿolos for prognostic prediction, but more studies are needed to validate its use in the general population.
IgA肾病（IgAN）是最常见且异质性的肾小球肾病。已采用多种策略来确定进展至终末期肾病（ESRD）的风险。我们评估了IgA肾病进展计算器（IgANPC）和牛津/MEST-C评分在我们研究人群中的预后意义并进行相关性分析。
我们对1990年至2015年经活检确诊为IgA肾病的患者进行了回顾性研究。我们使用MEST-C评分对活检标本进行分类，并将该评分与临床病程进行相关性分析。我们还在活检时使用在线IgANPC计算进展风险。
我们分析了48例活检标本，其中83%为男性，活检时平均年龄45岁。根据MEST-C评分，活检结果为E1的患者的IgANPC评分高于E0患者（P = 0.021）。新月体百分比与IgANPC风险评分的Pearson相关性具有统计学意义（P = 0.014），r = 0.357。低风险组（IgANPC的第1组）10年时估算肾小球滤过率（eGFR）高于30 ml/min的患者百分比为100%，高风险组（第3组）为0%，对数秩检验P = 0.001。MEST-C评分变量的对数秩比较显示E（0.036）和S（0.022）与eGFR时间<30 ml/min之间存在统计学显著结果。在T1与eGFR<30 ml/min之间也观察到统计学显著关系。IgANPC与eGFR<30 ml/min的多变量Cox回归分析显示风险组与eGFR<30 ml/min之间存在强相关性（P = 0.016）。
在我们的研究人群中，IgANPC可预测eGFR<30 ml/min的时间，并提供独立于MEST的信息。MEST-C分类和IgANPC是用于预后预测的有用且独立的工具，但需要更多研究来验证其在一般人群中的应用。
