Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis.

Autor:	Barbour SJ; Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.; BC Renal, Vancouver, British Columbia, Canada., Coppo R; Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy., Er L; BC Renal, Vancouver, British Columbia, Canada., Pillebout E; Nephrology Unit, Saint Louis Hospital, Paris, France., Russo ML; Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy., Alpers CE; Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington., Fogo AB; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee., Ferrario F; Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy., Jennette JC; Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina., Roberts ISD; Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom., Cook HT; Imperial College London, London, United Kingdom., Ding J; Department of Pediatrics, Peking University First Hospital, Beijing, China., Su B; Department of Pediatrics, Peking University First Hospital, Beijing, China., Zhong X; Department of Pediatrics, Peking University First Hospital, Beijing, China., Fervenza FC; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota., Zand L; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota., Peruzzi L; Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute della Scienza di Torino, Turin, Italy., Lucchetti L; Division of Nephrology, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy., Katafuchi R; Kidney Unit, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan., Shima Y; Department of Pediatrics, Wakayama Medical University, Wakayama, Japan., Yoshikawa N; Clinical Research Center, Takatsuki General Hospital, Wakayam Medical University, Takatsuki City, Japan., Ichikawa D; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan., Suzuki Y; Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan., Murer L; Pediatric Nephrology Dialysis and Transplant Unit, Department of Women's and Child's Health, Azienda Ospedaliera-University of Padova, Padua, Italy., Wyatt RJ; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee., Park C; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee., Nelson RD; Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah., Narus JH; Pediatrics Clinical Trials Office, University of Utah, Salt Lake City, Utah., Wenderfer S; Division of Pediatric Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.; Texas Children's Hospital, Houston, Texas., Geetha D; Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Daugas E; Nephrology, Bichat Hospital, AP-HP, Paris, France.; INSERM U1149 and Université Paris Cité, Paris, France., Monteiro RC; Centre for Research on Inflammation, Bichat Hospital, Inserm and Université Paris Cité, Paris, France., Nakatani S; Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan., Mastrangelo A; Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCC Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Nuutinen M; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.; PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland., Koskela M; Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Weber LT; Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany., Hackl A; Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany., Pohl M; Medical Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Pecoraro C; Comitato Tecnico Scientifico per la Ricerca e Innovaziione, A.O. Santobono-Pausilipon, Naples, Italy., Tsuboi N; Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan., Yokoo T; Department of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan., Takafumi I; Kidney Center, Department of Internal Medicine, Nephrology, Teikyo University School of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan., Fujimoto S; Division of Dialysis, Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan., Conti G; Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, University of Messina, Messina, Italy., Santoro D; Nephrology and Dialysis Unit AOU, G. Martino, University of Messina, Messina, Italy., Materassi M; Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy., Zhang H; Renal Division, Peking University First Hospital, Beijing, China., Shi S; Kidney Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China., Liu ZH; National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China., Tesar V; Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic., Maixnerova D; Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic., Avila-Casado C; Department of Pathology, University of Toronto, Toronto, Ontario, Canada., Bajema I; Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands., Barreca A; Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy., Becker JU; Institute of Pathology, University Hospital of Cologne, Cologne, Germany., Comstock JM; Department of Pathology, University of Utah, Salt Lake City, Utah., Cornea V; Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky., Eldin K; Department of Pathology, Mass General Brigham, Salem Hospital, Salem, Massachusetts., Hernandez LH; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota., Hou J; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California., Joh K; Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan., Lin M; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California., Messias N; Department of Pathology, Washington University in Saint Louis, St. Louis, Missouri., Muda AO; Bambino Gesù Children's Hospital-IRCCS, Rome, Italy., Pagni F; Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy., Diomedi-Camassei F; Pathology Department, Bambino Gesù Children's Hospital, Rome, Italy., Tokola H; Pathology, University Oulu and Oulu University Hospital, Oulu, Finland., D'Armiento M; Pathology Section, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy., Seidl M; Medical Center-University of Freiburg and Faculty of Medicine, Institute for Surgical Pathology, University of Freiburg, Freiburg, Germany., Rosenberg A; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Sannier A; Department of Pathology, AP-HP, Hôpital Bichat, Université Paris Cité, Paris, France., Soares MF; Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom., Wang S; Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China., Zeng C; National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China., Haas M; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2024 Apr 01; Vol. 19 (4), pp. 438-451. Date of Electronic Publication: 2024 Jan 23.
DOI:	10.2215/CJN.0000000000000398
Abstrakt:	Background: Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. Methods: Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. Results: M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. Conclusions: Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification. (Copyright © 2024 by the American Society of Nephrology.)
Databáze:	MEDLINE
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