title: Risk stratification for progression of IgA nephropathy using a decision tree induction algorithm.
abstract: BACKGROUND
  Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and many patients are at risk of at least slow progression. However, prediction of the renal outcome in individual patients remains difficult.
  
  
  METHODS
  To develop a practical and user-friendly scheme for risk stratification of IgAN patients, data were extracted from a prospective cohort study conducted in 97 clinical units in Japan from 1995. Specifically, we examined deterioration in renal function, defined as doubling of serum creatinine, within 10 years of follow-up in 790 adult IgAN patients without substantial renal dysfunction at baseline using a decision tree induction algorithm.
  
  
  RESULTS
  Recursive partitioning indicated that the best single predictor of renal deterioration was severe proteinuria on urine dipstick testing, followed by hypoalbuminaemia and the presence of mild haematuria for patients with and without severe proteinuria, respectively. Serum total protein levels, diastolic blood pressure and histological grade were placed in the third tier of the decision tree model. With these six variables, patients can be readily stratified into seven risk groups whose incidence of renal deterioration within 10-year follow-up ranges from 1.0% to 51.4%. Logistic regression also identified severe proteinuria, hypoalbuminaemia and mild haematuria as significant predictors of deterioration. Areas under the receiver-operating characteristic curve for the prediction were comparable between the decision tree model and the logistic regression model [0.830 (95% confidence interval, 0.777-0.883) versus 0.808 (95% confidence interval, 0.754-0.861)].
  
  
  CONCLUSIONS
  Risk of substantial renal deterioration in IgAN patients can be validly estimated using six predictors obtained from clinical routine.
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan. goto@msa.biglobe.ne.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Goto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.forename: Masayuki
authors.initials: M
authors.lastname: Endoh
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomino
mesh_terms: D000328:Adult; D000465:Algorithms; D003663:Decision Trees; D018450:Disease Progression; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D055815:Young Adult