Kidney Week

Abstract: TH-OR113

Analysis of 40-Year Prognosis of 1149 cases of IgA Nephropathy and Validation Study of Oxford Classification

Session Information

• Mostly IgA Nephropathy
  November 07, 2019 | Location: Ballroom C, Walter E. Washington Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Moriyama, Takahito, Tokyo Women's Medical University, Tokyo, Japan

Takahito Moriyama, MD, PhD



2017-present Associate professor, Department of Nephrology, Tokyo Women’s Medical University, Tokyo Japan 2008-2017 Assistant professor, Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan 2006-2007 Postdoctoral Fellow, Division of Nephrology and Kidney Disease Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA 2005-2006 Postdoctoral Fellow, Department of Pathology, Louisiana state university health sciences center, Shreveport, LA, USA 2002-2005 Senior Resident, Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan 2000-2002 Medical Staff, Department of Nephrology, Saiseikai Kawaguchi Hospital, Saitama, Japan 1998-2000 Junior Resident, Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan 1998 　 　 Passed the the National Examination for Medical Practitioners

• Nitta, Kosaku, Tokyo Women's Medical University, Tokyo, Japan

Kosaku Nitta,

Background

Half a century has passed since IgA nephropathy (IgAN) was firstly reported, however, very long term prognosis over 40 years has been unknown. In 2016, Oxford classification of IgAN was revised, and crescent formation was newly added. In this study, we showed 40 years prognosis of IgAN and validation study of Oxford classification in our cohort.

Methods

1,149 IgAN patients diagnosed in our institution since 1974 were analyzed. At first, 40 years prognosis of whole cohort was analyzed. Then, 872 patients observed over 1 years and diagnosed by renal biopsy with more than 8 glomeruli were divided into two groups with or without immunosuppressant and evaluated about the Oxford classification.

Results

Renal survival rate of whole cohort was 86.8% in 10 years, 72.2% in 20 years, 58.2% in 30 years, and 49.9% in 40 years. In whole Oxford analysis cohort (n=872), only T lesion was related with 20 years renal prognosis (81.9 in T0, 58.7 in T1, and 34.7% in T2, P<0.0001). In group without immunosuppressant (n=416), 20 years renal survival rate was significantly higher in S0 than S1 (75.7 vs. 65.0%, P=0.04), in T0 than T1 and 2 (77.4 vs. 59.1 vs. 18.0%, P<0.0001), in C0 than C1+2 (71.9 vs. 60.1%, P=0.023), but not significant in M and E. In group with immunosuppressant (n=456), it was significantly higher in only T0 than T1 and 2 (87.3 vs. 55.7 vs. 54.7%, P<0.0001). Interestingly, survival rate in C1 (80.8%) was increased similar to C0 (76.6%) by immunosuppressant, but C2 was still low (58.8%). Multivariate Cox regression analysis showed lower eGFR and higher amount of proteinuria in every cohorts and T lesion in whole Oxford analysis cohort were independent risk factors. After propensity score matching (n=266/group), renal survival rate in group with immunosuppressant was significantly higher than without immunosuppressant (78.4 vs. 68.1%, p=0.0099), and it was also significantly higher than in M0 (83.0 vs. 70.1%, p=0.0277), E1 (85.2 vs. 65.1%, p=0.0051), S1 (80.0 vs. 63.5%, p=0.0031), T0 (91.6 vs. 81.6, p=0.003), T2 (62.5 vs. 0.0%, p=0.035), and C1 (82.5 vs. 62.5%, p=0.014).

Conclusion

Half of IgAN patients progressed to end stage within 40 years, and Oxford classification was evaluated to suspect prognosis especially T lesion, and immunosuppressant improved its prognosis especially in M0, E1, S1, T0, T2 and C1.