Validation of a Histologic Scoring Index for C3 Glomerulopathy
Por:
Caravaca-Fontan, F, Trujillo, H, Alonso, M, Diaz-Encarnacion, M, Cabello, V, Ariceta, G, Quintana, LF, Marco, H, Barros, X, Ramos, N, Rodriguez-Mendiola, N, Cruz, S, Fernandez-Juarez, G, Rodriguez, E, de la Cerda, F, de Jose, AP, Lopez, I, Fernandez, L, Gomez, VP, Avila, A, Bravo, L, Lumbreras, J, Allende, N, de la Nieta, MDS, Olea, T, Melgosa, M, Huerta, A, Miquel, R, Mon, C, Fraga, G, de Lorenzo, A, Draibe, J, Gonzalez, F, Shabaka, A, Illescas, ML, Calvo, C, Oviedo, V, Da Silva, I, de Jorge, EG, Caravaca, F and Praga, M
Publicada:
1 may 2021
Ahead of Print:
1 abr 2021
Resumen:
Rationale & Objective: A previous study that evaluated associations of kidney biopsy findings with disease progression in patients with C3 glomerulopathy (C3G) proposed a prognostic histologic index (C3G-HI) that has not yet been validated. Our objective was to validate the performance of the C3G-HI in a new patient population.
Study Design: Multicenter, retrospective cohort study.
Setting & Participants: 111 patients fulfilling diagnostic criteria of C3G between January 1995 and December 2019, from 33 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN).
Predictors: Demographic, clinical parameters, C3G-HI total activity score, and the C3G-HI total chronicity score.
Outcome: Time to kidney failure.
Analytical Approach: Intraclass correlation coefficients and. statistic were used to summarize inter-rater reproducibility for assessment of histopathology in kidney biopsies. The nonlinear relationships of risk of kidney failure with the total activity score and total chronicity score were modeled using Cox proportional hazards analysis that incorporated cubic splines.
Results: The study group included 93 patients with C3 glomerulonephritis and 18 with densedeposit disease. Participants had an overall mean age of 35 +/- 22 (SD) years. Forty-eight patients (43%) developed kidney failure after a mean follow-up of 65 +/- 27 months. The overall inter-rater reproducibility was very good for the total activity score (intraclass correlation coefficient [ICC] = 0.63) and excellent for total chronicity score (ICC = 0.89). Baseline estimated glomerular filtration rate (eGFR), 24-hour proteinuria, and treatment with immunosuppression were the main determinants of kidney failure in a model with only clinical variables. Only tubular atrophy and interstitial fibrosis were identified as predictors in a model with histological variables. When the total activity score and total chronicity score were added to the model, only the latter was identified as an independent predictor of kidney failure.
Limitations: Only a subset of the kidney biopsies was centrally reviewed. Residual confounding.
Conclusions: We validated the performance of C3G-HI as a predictor of kidney failure in patients with C3G. The total chronicity score was the principal histologic correlate of kidney failure.yyy
Filiaciones:
Caravaca-Fontan, F:
Inst Invest Hosp 12 Octubre I 12, Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Trujillo, H:
Hosp Univ 12 Octubre, Dept Nephrol, Avda Corrdoba S-N, Madrid 28041, Spain
Alonso, M:
Hosp Univ 12 Octubre, Dept Pathol, Madrid, Spain
Diaz-Encarnacion, M:
Fdn Puigvert, Dept Nephrol, Barcelona, Spain
Cabello, V:
Hosp Univ Virgen del Rocio, Dept Nephrol, Seville, Spain
Ariceta, G:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Pediat Nephrol, Barcelona, Spain
Quintana, LF:
Hosp Clin Barcelona, Dept Nephrol, Barcelona, Spain
Univ Barcelona, IDIBAPS, Dept Med, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Nephrol, Barcelona, Spain
Barros, X:
Hosp Univ Doctor Josep Trueta, Dept Nephrol, Girona, Spain
Ramos, N:
Hosp Univ Vall dHebron, Dept Nephrol, Barcelona, Spain
Rodriguez-Mendiola, N:
Hosp Univ Ramon y Cajal, Dept Nephrol, Madrid, Spain
Cruz, S:
Hosp Univ Juan Ramon Jimenez, Dept Nephrol, Huelva, Spain
Fernandez-Juarez, G:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain
Rodriguez, E:
Hosp del Mar, Dept Nephrol, Barcelona, Spain
de la Cerda, F:
Hosp Univ Virgen del Rocio, Dept Pediat Nephrol, Seville, Spain
de Jose, AP:
Hosp Univ Gregorio Maranon, Dept Nephrol, Madrid, Spain
Lopez, I:
Hosp Univ Virgen de la Arrixaca, Dept Nephrol, Murcia, Spain
Fernandez, L:
Complejo Hosp Navarra, Dept Nephrol, Navarra, Spain
Gomez, VP:
Hosp Univ Fdn Jimenez Diaz, Dept Nephrol, Madrid, Spain
Avila, A:
Hosp Univ Doctor Peset, Dept Nephrol, Valencia, Spain
Bravo, L:
Hosp Univ A Coruna, Dept Nephrol, La Coruna, Spain
Lumbreras, J:
Hosp Univ Son Espases, Balearic Isl Hlth Res Inst IdISBa, Pediat Nephrol Unit, Palma De Mallorca, Spain
Allende, N:
Hosp Univ Son Espases, Dept Nephrol, Palma De Mallorca, Spain
de la Nieta, MDS:
Hosp Gen Univ Ciudad Real, Dept Nephrol, Ciudad Real, Spain
Olea, T:
Hosp Univ La Paz, Dept Nephrol, Madrid, Spain
Melgosa, M:
Hosp Univ La Paz, Dept Pediat Nephrol, Madrid, Spain
Huerta, A:
Hosp Univ Puerta Hierro, Dept Nephrol, Madrid, Spain
Miquel, R:
Hosp Univ Canarias, Dept Nephrol, Tenerife, Spain
Mon, C:
Hosp Univ Severo Ochoa, Dept Nephrol, Madrid, Spain
Fraga, G:
Univ Autonoma Barcelona, Dept Pediat Nephrol, Hosp Santa Creu & St Pau, Barcelona, Spain
de Lorenzo, A:
Hosp Univ Getafe, Dept Nephrol, Madrid, Spain
Draibe, J:
Hosp Univ Bellvitge, Dept Nephrol, Barcelona, Spain
Gonzalez, F:
Hosp Doctor Negrin, Dept Nephrol, Gran Canaria, Spain
Shabaka, A:
Hosp Univ Clin San Carlos, Dept Nephrol, Madrid, Spain
Illescas, ML:
Complejo Hosp Univ Albacete, Dept Nephrol, Albacete, Spain
Calvo, C:
Hosp Gen Univ Castellon, Dept Nephrol, Castellon de La Plana, Spain
Oviedo, V:
Hosp Univ Marques de Valdecilla, Dept Nephrol, Santander, Spain
Da Silva, I:
Fdn Puigvert, Dept Nephrol, Barcelona, Spain
de Jorge, EG:
Univ Complutense Madrid, Dept Immunl, Madrid, Spain
CSIC, Ctr Invest Biol, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Raras, Madrid, Spain
Caravaca, F:
Hosp Univ Badajoz, Dept Nephrol, Badajoz, Spain
Praga, M:
Inst Invest Hosp 12 Octubre I 12, Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Hosp Univ 12 Octubre, Dept Nephrol, Avda Corrdoba S-N, Madrid 28041, Spain
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