Abstract: SA-PO693
Histological Classifications in IgA Nephropathy Should be Considered for Predicting Not Only Renal Functional Decline but Also Treatment Response
Session Information
- Pathology and Lab Medicine: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1602 Pathology and Lab Medicine: Clinical
Authors
- Joh, Kensuke, The Jikei University School of Medicine, Tokyo, Japan
- Hashiguchi, Akinori, Keio University School of Medicine, Tokyo, Japan
- Shimizu, Akira, Nippion Medical School, Tokyo, Japan
- Katafuchi, Ritsuko, National Hospital Organization Fukuokahigashi Medical Center, Koga, Fukuoka, Japan
- Hisano, Satoshi, University of Occupational and Environment Health, Kitakyushu, Japan
- Kawamura, Tetsuya, The Jikei University School of Medicine, Tokyo, Japan
Background
In IgA nephropathy, Oxford classification (Oxford) (MESTC) and Japanese Histological Grade Classification (JHGC) (Gr1-Gr4, A: active crescent, C: global or segmental sclerosis) are evidence-based classification, which have been produced for predicting renal functional decline (RFD). However, clinical parameters are also selected as independent parameters besides histological parameters for RFD. The purpose was to detect the histological parameters, which show a significant correlation with these clinical parameters, because the detected histological parameters can be main indicators for the choice of therapy.
Methods
The 906 Japanese patients with IgA nephropathy (male：49%, median age: 38 yrs) were prospectively followed for a median of 62 months. First, histological and clinical parameters were evaluated by multivariate Cox regression analysis for 1.5 time's increase of serum creatinine to find clinical independent parameters. Thereafter, structural equation modeling (SEM) (STATA, Light Stone, USA) was used to find histological parameters which correlate with the independent clinical parameters for RFD.
Results
Besides M, T1, T2 in Oxford and Gr1-Gr4 in JHGC as the independent histological parameters, amount of proteinuria at renal biopsy (PU0) and steroid therapy (ST) were selected as the independent clinical parameters in both classifications. In SEM, histological parameters which correlated with ST were S（coefficient 0.10）, C1（0.20）, C2（0.30）, and E（0.11）in Oxford and AorA/C（0.27）in JHGC for renal functional improvement (RFI: 0.75 in Oxford and 0.81 in JHGC). The histological parameters which correlated with PU0 were C1 (0.39), M(1.08) and eGFR0 (-0.01) in Oxford and Gr3（1.03), Gr4（1.61), eGFR0 (-0.01), AorA/C（0.27）in JHGC for RFD (-0.06 in Oxford and -0.06 in JHGC).
Conclusion
Since S, C1, C2, and E in Oxford and AorA/C in JHGC were treatment’s targets for ST resulting in RFI, these histological parameters in each classification are reasonable indicators for a choice of ST. The histological parameters, which correlated with PU0, consisted of ST-related parameters and non-ST related parameters. Therefore, both histological classifications can be more practical considering aforementioned histology-based choice of therapy.