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

Sean J. Barbour, Rosanna Coppo, Lee Er, Evangeline Pillebout, Maria Luisa Russo, Charles E. Alpers, Agnes B. Fogo, Franco Ferrario, J. Charles Jennette, Ian S.D. Roberts, H. Terence Cook, Jie Ding, Baige Su, Xuhui Zhong, Fernando C. Fervenza, Ladan Zand, Licia Peruzzi, Laura Lucchetti, Ritsuko Katafuchi, Yuko ShimaNorishige Yoshikawa, Daisuke Ichikawa, Yusuke Suzuki, Luisa Murer, Robert J. Wyatt, Catherine Park, Raoul D. Nelson, Joann H. Narus, Scott Wenderfer, Duvuru Geetha, Eric Daugas, Renato C. Monteiro, Shinya Nakatani, Antonio Mastrangelo, Matti Nuutinen, Mikael Koskela, Lutz T. Weber, Agnes Hackl, Martin Pohl, Carmine Pecoraro, Nobuo Tsuboi, Takashi Yokoo, Ito Takafumi, Shouichi Fujimoto, Giovanni Conti, Domenico Santoro, Marco Materassi, Hong Zhang, Sufang Shi, Zhi Hong Liu, Vladimir Tesar, Dita Maixnerova, Carmen Avila-Casado, Ingeborg Bajema, Antonella Barreca, Jan U. Becker, Jessica M. Comstock, Virgilius Cornea, Karen Eldin, Loren Herrera Hernandez, Jean Hou, Kensuke Joh, Mercury Lin, Nidia Messias, Andrea Onetti Muda, Fabio Pagni, Francesca Diomedi-Camassei, Heikki Tokola, Maria D'Armiento, Maximilian Seidl, Avi Rosenberg, Aurélie Sannier, Maria Fernanda Soares, Suxia Wang, Caihong Zeng, Mark Haas

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundNephritis 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.MethodsBiopsies 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.ResultsM, 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.ConclusionsKidney 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.

Original languageEnglish (US)
Pages (from-to)438-451
Number of pages14
JournalClinical Journal of the American Society of Nephrology
Volume19
Issue number4
DOIs
StatePublished - Apr 2024

Keywords

  • GN
  • Henoch-Schonlein purpura (IgA vasculitis)
  • kidney biopsy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation
  • Epidemiology

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