The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods. © 2015 International Society of Nephrology.

The MEST score provides earlier risk prediction in lgA nephropathy / Barbour, Sean J.; Espino Hernandez, Gabriela; Reich, Heather N.; Coppo, Rosanna; Roberts, Ian S. D.; Feehally, John; Herzenberg, Andrew M.; Cattran, Daniel C; Bavbek, N.; Cook, T.; Troyanov, S.; Alpers, C.; Amore, A.; Barratt, J.; Berthoux, F.; Bonsib, S.; Bruijn, J.; D'Agati, V.; D'Amico, G.; Emancipator, S.; Emmal, F.; Ferrario, F.; Fervenza, F.; Florquin, S.; Fogo, A.; Geddes, C.; Groene, H.; Haas, M.; Hill, P.; Hogg, R.; Hsu, S.; Hunley, T.; Hladunewich, M.; Jennette, C.; Joh, K.; Julian, B.; Kawamura, T.; Lai, F.; Leung, C.; Li, L.; Li, P.; Liu, Z.; Massat, A.; Mackinnon, B.; Mezzano, S.; Schena, F.; Tomino, Y.; Walker, P.; Wang, H.; Weening, J.; Yoshikawa, N.; Zhang, H.; Coppo, R.; Troyanov, S.; Cattran, D. C.; Cook, H. T.; Feehally, J.; Roberts, I.; Tesar, V.; Maixnerova, D.; Lundberg, S.; Gesualdo, L.; Emma, F.; Fuiano, L.; Beltrame, G.; Rollino, C.; Amore, A.; Camilla, R.; Peruzzi, L.; Praga, M.; Feriozzi, S.; Polci, R.; Segoloni, G.; Colla, L.; Pani, A.; Angioi, A.; Piras, L.; Cancarini, G.; Ravera, S.; Durlik, M.; Moggia, E.; Ballarin, J.; Di Giulio, S.; Pugliese, F.; Serriello, Ilaria; Caliskan, Y.; Sever, M.; Kilicaslan, I.; Locatelli, F.; Del Vecchio, L.; Wetzels, J. F. M.; Peters, H.; Berg, U.; Carvalho, F.; Da Costa Ferreira, A. C.; Maggio, M.; Wiecek, A.; Ots Rosenberg, M.; Magistroni, R.; Topaloglu, R.; Bilginer, Y.; D'Amico, M.; Stangou, M.; Giacchino, F.; Goumenos, D.; Kalliakmani, P.; Gerolymos, M.; Galesic, K.; Geddes, C.; Siamopoulos, K.; Balafa, O.; Galliani, M.; Stratta, P.; Quaglia, M.; Bergia, R.; Cravero, R.; Salvadori, M.; Cirami, L.; Fellstrom, B.; Kloster Smerud, H.; Ferrario, F.; Stellato, T.; Egido, J.; Martin, C.; Floege, J.; Eitner, F.; Lupo, A.; Bernich, P.; Mene', Paolo; Morosetti, M.; Van Kooten, C.; Rabelink, T.; Reinders, M. E. J.; Boria Grinyo, J. M.; Cusinato, S.; Benozzi, L.; Savoldi, S.; Licata, C.; Mizerska Wasiak, M.; Martina, G.; Messuerotti, A.; Dal Canton, A.; Esposito, C.; Migotto, C.; Triolo, G.; Mariano, F.; Pozzi, C.; Boero, R.; Bellur, S.; Mazzucco, G.; Giannakakis, Konstantinos; Honsova, E.; Sundelin, B.; Di Palma, A. M.; Ferrario, F.; Gutiérrez, E.; Asunis, A. M.; Barratt, J.; Tardanico, R.; Perkowska Ptasinska, A.; Arce Terroba, J.; Fortunato, M.; Pantzaki, A.; Ozluk, Y.; Steenbergen, E.; Soderberg, M.; Riispere, Z.; Furci, L.; Orhan, D.; Kipgen, D.; Casartelli, D.; Galesic Ljubanovic, D.; Gakiopoulou, H.; Bertoni, E.; Cannata Ortiz, P.; Karkoszka, H.; Groene, H. J.; Stoppacciaro, Antonella; Bajema, I.; Bruijn, J.; Fulladosa Oliveras, X.; Maldyk, J.; Ioachim, E.. - In: KIDNEY INTERNATIONAL. - ISSN 0085-2538. - ELETTRONICO. - 89:1(2016), pp. 167-175. [10.1038/ki.2015.322]

The MEST score provides earlier risk prediction in lgA nephropathy

SERRIELLO, ILARIA;Locatelli, F.;MENE', Paolo;GIANNAKAKIS, Konstantinos;STOPPACCIARO, ANTONELLA;
2016

Abstract

The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods. © 2015 International Society of Nephrology.
2016
glomerular disease; IgA nephropathy; renal pathology; adult; atrophy; biopsy; disease progression; female; fibrosis; follow-up studies; glomerular filtration rate; glomerulonephritis, IGA; humans; kidney; kidney failure chronic; male; mesangial cells; middle aged; predictive value of tests; prognosis; risk assessment; medicine; nephrology
01 Pubblicazione su rivista::01a Articolo in rivista
The MEST score provides earlier risk prediction in lgA nephropathy / Barbour, Sean J.; Espino Hernandez, Gabriela; Reich, Heather N.; Coppo, Rosanna; Roberts, Ian S. D.; Feehally, John; Herzenberg, Andrew M.; Cattran, Daniel C; Bavbek, N.; Cook, T.; Troyanov, S.; Alpers, C.; Amore, A.; Barratt, J.; Berthoux, F.; Bonsib, S.; Bruijn, J.; D'Agati, V.; D'Amico, G.; Emancipator, S.; Emmal, F.; Ferrario, F.; Fervenza, F.; Florquin, S.; Fogo, A.; Geddes, C.; Groene, H.; Haas, M.; Hill, P.; Hogg, R.; Hsu, S.; Hunley, T.; Hladunewich, M.; Jennette, C.; Joh, K.; Julian, B.; Kawamura, T.; Lai, F.; Leung, C.; Li, L.; Li, P.; Liu, Z.; Massat, A.; Mackinnon, B.; Mezzano, S.; Schena, F.; Tomino, Y.; Walker, P.; Wang, H.; Weening, J.; Yoshikawa, N.; Zhang, H.; Coppo, R.; Troyanov, S.; Cattran, D. C.; Cook, H. T.; Feehally, J.; Roberts, I.; Tesar, V.; Maixnerova, D.; Lundberg, S.; Gesualdo, L.; Emma, F.; Fuiano, L.; Beltrame, G.; Rollino, C.; Amore, A.; Camilla, R.; Peruzzi, L.; Praga, M.; Feriozzi, S.; Polci, R.; Segoloni, G.; Colla, L.; Pani, A.; Angioi, A.; Piras, L.; Cancarini, G.; Ravera, S.; Durlik, M.; Moggia, E.; Ballarin, J.; Di Giulio, S.; Pugliese, F.; Serriello, Ilaria; Caliskan, Y.; Sever, M.; Kilicaslan, I.; Locatelli, F.; Del Vecchio, L.; Wetzels, J. F. M.; Peters, H.; Berg, U.; Carvalho, F.; Da Costa Ferreira, A. C.; Maggio, M.; Wiecek, A.; Ots Rosenberg, M.; Magistroni, R.; Topaloglu, R.; Bilginer, Y.; D'Amico, M.; Stangou, M.; Giacchino, F.; Goumenos, D.; Kalliakmani, P.; Gerolymos, M.; Galesic, K.; Geddes, C.; Siamopoulos, K.; Balafa, O.; Galliani, M.; Stratta, P.; Quaglia, M.; Bergia, R.; Cravero, R.; Salvadori, M.; Cirami, L.; Fellstrom, B.; Kloster Smerud, H.; Ferrario, F.; Stellato, T.; Egido, J.; Martin, C.; Floege, J.; Eitner, F.; Lupo, A.; Bernich, P.; Mene', Paolo; Morosetti, M.; Van Kooten, C.; Rabelink, T.; Reinders, M. E. J.; Boria Grinyo, J. M.; Cusinato, S.; Benozzi, L.; Savoldi, S.; Licata, C.; Mizerska Wasiak, M.; Martina, G.; Messuerotti, A.; Dal Canton, A.; Esposito, C.; Migotto, C.; Triolo, G.; Mariano, F.; Pozzi, C.; Boero, R.; Bellur, S.; Mazzucco, G.; Giannakakis, Konstantinos; Honsova, E.; Sundelin, B.; Di Palma, A. M.; Ferrario, F.; Gutiérrez, E.; Asunis, A. M.; Barratt, J.; Tardanico, R.; Perkowska Ptasinska, A.; Arce Terroba, J.; Fortunato, M.; Pantzaki, A.; Ozluk, Y.; Steenbergen, E.; Soderberg, M.; Riispere, Z.; Furci, L.; Orhan, D.; Kipgen, D.; Casartelli, D.; Galesic Ljubanovic, D.; Gakiopoulou, H.; Bertoni, E.; Cannata Ortiz, P.; Karkoszka, H.; Groene, H. J.; Stoppacciaro, Antonella; Bajema, I.; Bruijn, J.; Fulladosa Oliveras, X.; Maldyk, J.; Ioachim, E.. - In: KIDNEY INTERNATIONAL. - ISSN 0085-2538. - ELETTRONICO. - 89:1(2016), pp. 167-175. [10.1038/ki.2015.322]
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