Abstract: TH-PO098

Utility of Subgroups of the Japanese Histological Grade Classification of IgA Nephropathy to Evaluate Effectiveness of Therapy

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Joh, Kensuke, Tohoku University Graduate School of Medicine, Sendai, Japan
  • Hashiguchi, Akinori, Keio University School of Medicine, Tokyo, Japan
  • Hisano, Satoshi, Fukuoka University School of Medicine, Fukuoka, Japan
  • Shimizu, Akira, Nippion Medical School, Tokyo, Japan
  • Katafuchi, Ritsuko, National Fukuoka-Higashi Medical Center, Fukuoka, Japan
  • Kawamura, Tetsuya, The Jikei University School of Medicine, Tokyo, Japan
Background

Japanese Histological Grade Classification (JHGC; HG1-HG4) (J Nephrol, 2013) is a lumped system grading glomerular lesions constituting of active crescent, global sclerosis, segmental sclerosis (S) and fibrous crescent. Each group is divided into subgroups constituting of active lesion (A), chronic lesions (C), and mixed lesions (A/C) The purpose was to investigate a utility of these subgroups to evaluate an effectiveness of therapy in a cohort of a Japanese IgA nephropathy (IgAN) prospective cohort study.

Methods

Sequential clinical data as well as renal biopsies were obtained from 847 Japanese patients (pts) with IgAN (male 49%) collected from 32 centers in Japan. The pts, whose median age was 36 years old, were prospectively followed for a median of 42 months. The average amount of proteinuria at the time of the biopsy was 1.1 g/day. Mean eGFR was 76±29 ml/min/1.73m2. Pts was divided into group A or A/C (320 pts), group C (410pts), and group without A, A/C, or C (117 pts). Percent of the cases receiving steroid therapy with/without tonsillectomy (ST) and those receiving tonsillectomy with/without ST (Tons) were 79% and 41%, respectively in group A or A/C, whereas ST and Tons were 58% and 31% in group C, respectively. An effectiveness of these choices of therapy was evaluated by multivariate Cox regression analysis to predict renal functional decline (RFD) for 1.5 time's increase of serum creatinine (sCr) and proteinuric remission (PUR) for an endpoint of proteinuria as 0.3 g/day.

Results

In group A or A/C, ST or Tons besides HG3 and HG4 were selected as independent parameters for RFD, whereas HG2, HG3 and HG4 but not ST or Tons were selected in group C, even after adjustment by RAS blockade, initial mean arterial pressure (MAP), initial proteinuria, and initial eGFR (p<0.05). For PUR, ST besides HG 3 were selected as independent predictors in group A or A/C, whereas ST besides HG3, and HG4 were selected in in group C after adjustment by aforementioned clinical parameters (p<0.05).

Conclusion

A utility of the subgroups of JHGC was appraised for an evaluation of an effectiveness of therapy. The cases with A or A/C but not C is a target of ST and Tons for RFD, whereas for PUR, ST can be applied not only for the pts with A or A/C but also for the pts with C.

Funding

  • Government Support - Non-U.S.