A validated model of disease progression in IgA nephropathy.
BACKGROUND
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the general population. There is accumulating evidence that immunosuppressive treatment is efficacious in IgAN. However, it is critical to define appropriate indicators for this therapy especially in the wake of potentially deleterious side effects to immunosuppressives.


METHODS
This study retrospectively reviewed IgAN cases collected since 1981 to identify clinical and/or histological parameters for disease progression; 310 patients with biopsy proven IgAN, diagnosed from January 1981 to March 2004, were included.


RESULTS
We defined a clinical prognostic index (CPI) using multivariate analysis, which incorporated these clinical/ histological parameters. Semiquantitative scores were assigned as follows: 2 points if creatinine (Cr) was >1.4 mg/dL, 1 point if proteinuria was >1 g/24 hr, 1 point if a patient was affected by hypertension, and 1 point if a patient was older than 30 yrs. Dividing our population into two groups (scores 0-2 = low CPI group; scores 3-5 = high CPI group), we demonstrated a significantly different 10-yr renal survival rate; in the low CPI group, renal survival since time of biopsy at 10 yrs was 91.7%; in the high CPI group the renal survival at 10 yrs was 35%. We validated the CPI in an independent sample from Verona (validation group) and demonstrated similar results for the CPI.


CONCLUSIONS
The CPI is convenient to use for defining the risk of disease progression.
Magistroni
Richardo
R
Division of Nephrology, University of Modena and Reggio Emilia, Italy. Magistroni.Riccardo@unimore.it
Furci
Luciana
L
Leonelli
Marco
M
Masellis
Mario
M
Ligabue
Giulia
G
Lucchi
Leonardo
L
Lupo
Antonio
A
Brezzi
Brigida
B
Gambaro
Giovanni
G
Manganelli
Luca
L
Pedrazzi
Giada
G
Ricardi
Marco
M
Bormioli
Luisa
L
Albertazzi
Alberto
A
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D007166:Immunosuppressive Agents