Association of Histologic Parameters with Outcome in C3 Glomerulopathy and Idiopathic Immunoglobulin-Associated Membranoproliferative Glomerulonephritis.

Autor:	Lomax-Browne HJ; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom., Medjeral-Thomas NR; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom., Barbour SJ; Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada., Gisby J; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom., Han H; Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York., Bomback AS; Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York., Fervenza FC; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota., Cairns TH; West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom., Szydlo R; Department for Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom., Tan SJ; Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia., Marks SD; Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.; National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom., Waters AM; Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom., Appel GB; Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York., D'Agati VD; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York., Sethi S; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota., Nast CC; Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California., Bajema I; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Alpers CE; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington., Fogo AB; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee., Licht C; Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada., Fakhouri F; Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Cattran DC; Toronto General Research Institute, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada., Peters JE; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom., Cook HT; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom., Pickering MC; Department for Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2022 Jul; Vol. 17 (7), pp. 994-1007.
DOI:	10.2215/CJN.16801221
Abstrakt:	Background and Objectives: C3 glomerulopathy and idiopathic Ig-associated membranoproliferative GN are kidney diseases characterized by abnormal glomerular complement C3 deposition. These conditions are heterogeneous in outcome, but approximately 50% of patients develop kidney failure within 10 years. Design, Setting, Participants, & Measurements: To improve identification of patients with poor prognosis, we performed a detailed analysis of percutaneous kidney biopsies in a large cohort of patients. Using a validated histologic scoring system, we analyzed 156 native diagnostic kidney biopsies from a retrospective cohort of 123 patients with C3 glomerulopathy and 33 patients with Ig-associated membranoproliferative GN. We used linear regression, survival analysis, and Cox proportional hazards models to assess the relationship between histologic and clinical parameters with outcome. Results: Frequent biopsy features were mesangial expansion and hypercellularity, glomerular basement membrane double contours, and endocapillary hypercellularity. Multivariable analysis showed negative associations between eGFR and crescents, interstitial inflammation, and interstitial fibrosis/tubular atrophy. Proteinuria positively associated with endocapillary hypercellularity and glomerular basement membrane double contours. Analysis of second native biopsies did not demonstrate associations between immunosuppression treatment and improvement in histology. Using a composite outcome, risk of progression to kidney failure associated with eGFR and proteinuria at the time of biopsy, cellular/fibrocellular crescents, segmental sclerosis, and interstitial fibrosis/tubular atrophy scores. Conclusions: Our detailed assessment of kidney biopsy data indicated that cellular/fibrocellular crescents and interstitial fibrosis/tubular atrophy scores were significant determinants of deterioration in kidney function. (Copyright © 2022 by the American Society of Nephrology.)
Databáze:	MEDLINE
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