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Abstract: TH-PO092

Clinical Impact of Modified MESC Classification for Renal Outcome among Japanese IgAN Patients

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Kaihan, Ahmad Baseer, Nagoya University Graduate School of Medicine, Nagoya , Aichi-KEN, Japan
  • Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan
  • Katsuno, Takayuki, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Imaizumi, Takahiro, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan
  • Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan
  • Hishida, Manabu, Nagoya University Graduate School of Medicine, Nagoya , Aichi-KEN, Japan
  • Tsuboi, Naotake, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
Background

Our previous study revealed that MES and crescent (C) in the Oxford classifications could not predict real outcome among adult Japanese IgA nephropathy (IgAN) patients, probably because that Japanese IgAN patients were diagnosed in earlier and more active stage. The purpose of this study was to modify the cutoff point of MESC scores adequate for Japanese patients with IgAN.

Methods

A total of 86 adult IgAN patients diagnosed from 2001 to 2009 by renal biopsy retrospectively evaluated at Nagoya University Hospital by seven nephrologists. The ROC curve analyses were used to modify the traditional cutoff points for MESC. Then the modified and traditional MESC score was analyzed in association with renal outcome, defined as a 50% increase in serum creatinine.

Results

Baseline characteristics [median and IQR] of study subjects were: age 36 [24-46] years, 41 female, proteinuria 1.2 [0.7-1.8] g/day, and serum creatinine (sCr) 0.9 [0.7-1.1] mg/dL. The modified cutoff point for MESC was ≥ 40%, ≥ 10%, ≥ 20%, and ≥ 10% in glomeruli respectively. Number and proportion of traditional vs modified MESC were M1: 24 (27.9%) vs 30 (34.9%), E1: 35 (40.7%) vs 17 (19.8%), S1:57 (66.3%) vs, 20 (23.3%) and C1:45 (52.3%) vs 32 (37.2%). During a median follow-up period of 6.8 years, 13 (15%) patients achieved the renal outcome. In univariate analyses, the traditional MESC was not associated with renal outcome, while in modified cutoff point M (HR 2.99, p= 0.05), E (HR 4.94, p= 0.004), S (HR 3.51, p= 0.03), and C (HR 3.67, p= 0.03) were significantly associated with renal outcome. ROC curve analyses (Fig 1) revealed significant predictive value in modified MESC classification (AUC=0.851).

Conclusion

The modified cutoff points for MESC significantly improved predictive value for renal outcome in Japanese patients with IgAN.

Funding

  • Other U.S. Government Support