Concise semiquantitative histological scoring system for immunoglobulin A nephropathy.
OBJECTIVE
Immunoglobulin A nephropathy (IgAN) is a common and progressive glomerulonephritis. Histological lesions of IgAN are variable and considered as a risk factor for renal outcome. Establishing a relatively concise histological semiquantitative scoring system would be valuable in clinical practice.


METHODS
Renal biopsy sections of 293 patients with primary IgAN from two centres in China were reviewed. A histological scoring system was established based on multivariate survival analysis of semiquantitative histological indices, using end-stage renal disease (ESRD) as the end-point event.


RESULTS
Four indices--extracapillary glomerular activity index (exGAI), mesangial proliferation index (MsI), glomerular chronicity index (GCI) and tubulointerstitial chronicity index (TCI)--independently correlated with ESRD (relative risk (RR) = 1.16, 2.27, 1.29 and 1.80, respectively). The four indices and the sum of their scores (Total I) constituted the scoring system. Patients with exGAI of 4 or more, GCI of 4 or more, MsI of 2 or more and TCI of 2 or more were considered as having a higher risk for progression (P < 0.05). A score of 4 or more on the exGAI index could identify the patients who should be treated with immunosuppressive drugs, which showed a lower incidence of ESRD than that without (24.3% vs 52.4%, P = 0.031).


CONCLUSIONS
It suggested that the present concise scoring system could serve as prognostic and therapeutic indications.
Jiang
Lei
L
Renal Division of Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
Liu
Gang
G
Lv
Jicheng
J
Huang
Chaoxing
C
Chen
Bo
B
Wang
Suxia
S
Zou
Wanzhong
W
Zhang
Hong
H
Wang
Haiyan
H
D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies
D007166:Immunosuppressive Agents