Combining clinical features and MEST-C score in IgA nephropathy may be a better determinant of kidney survival


YETER H. H., Gonul I., Guz G., Helvaci O., Korucu B., Akcay O. F., ...More

Romanian journal of internal medicine = Revue roumaine de medecine interne, vol.58, no.4, pp.209-218, 2020 (ESCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 58 Issue: 4
  • Publication Date: 2020
  • Doi Number: 10.2478/rjim-2020-0025
  • Journal Name: Romanian journal of internal medicine = Revue roumaine de medecine interne
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, MEDLINE, Directory of Open Access Journals
  • Page Numbers: pp.209-218
  • Keywords: end stage kidney disease, glomerulonephritis, glucocorticoid, IgA nephropathy, Oxford classification
  • Dokuz Eylül University Affiliated: No

Abstract

Introduction. IgA nephropathy (IgAN) is a heterogeneous disease with highly variable clinical and histopathological features. We investigated the effects of Oxford classification and clinical features on renal survival in patients with IgAN.Methods. This retrospective observational study conducted from 2013 to 2017. Ninety-seven patients who were followed up more than six months were examined.Results. A total of 97 patients (68% male and median age 40 years) were enrolled in this study. 13% of patients developed end stage renal disease (ESRD) within the median of 37 months of follow-up. Need for renal replacement therapy at the time of diagnosis, serum creatinine level of higher than 1.97 mg/dl, serum albumin level less than 3.5 gr/dl, 24-hour urine protein level of higher than > 3.5 g/day, the percentage of glomerulosclerosis higher than 53%, T2 score and total MEST-C score higher than two were found to be significant predictors of development of ESRD. None of the clinical or histopathological features were found to be significant predictor of steroid treatment sensitivity except T1-2 scores.Conclusion. We think that IgA nephropathy is a heterogeneous disease that requires clinical and histopathological features to be evaluated together, but not individually, to determine renal survival.What is new. Iga nephropathy is a heterogeneous disease and modern pathologic classification systems is not enough to predict to prognosis. Histopathological features to be evaluated with clinical features, but not individually, to determine renal survival. Also glucocorticoid treatment response seems to be independent from clinical and histopathological features except T1-2 score.