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.
Renal Division of Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
Lei
L
Jiang
Gang
G
Liu
Jicheng
J
Lv
Chaoxing
C
Huang
Bo
B
Chen
Suxia
S
Wang
Wanzhong
W
Zou
Hong
H
Zhang
Haiyan
H
Wang
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