RESUMO
BACKGROUND AND OBJECTIVE: About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS: Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS: 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS: The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.
Assuntos
Anticorpos Monoclonais/sangue , Glomerulonefrite por IGA/sangue , Imunoglobulina A/imunologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de TempoRESUMO
BACKGROUND AND OBJECTIVE: About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS: Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS: 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS: The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.
Assuntos
Glomerulonefrite por IGA , Insuficiência Renal Crônica , Anticorpos Monoclonais , Galactose , Humanos , Imunoglobulina A , LectinasRESUMO
INTRODUCCIÓN: La nefropatía IgA es la enfermedad glomerular más frecuente y heterogénea. Hay estrategias histológicas y clínicas para determinar la progresión a ESRD. Valoramos el significado pronóstico de la clasificación de Oxford/MEST-C y la calculadora de progresión de la NIgA (IgANPC) en nuestra población y relacionamos ambas herramientas. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de biopsias NIgA de 1990 hasta 2015. Se realizó el MEST de las biopsias y se calculó el riesgo de progresión con IgANPC. Se relaciona con la evolución clínica. RESULTADOS: Se analizaron 48 biopsias, 83% varones de 45 años de media. La correlación entre el MEST-C y el IgANPC score a la biopsia mostró una concordancia entre pacientes con un score IgANPC alto y E1 (p = 0,021). La correlación de Pearson para el porcentaje de semilunas y el IgAPC es estadísticamente significativo (p = 0,014) con r: 0,357. El 100% de los pacientes clasificados en el grupo 1 de IgANPC mantienen un FGe > 30 ml/min a 10 años, mientras que ninguno de los del grupo 3 presenta un FGe > 30 ml/min a 10 años (p = 0,001). La comparación de log rank para variables del MEST-C score presenta resultados estadísticamente significativos entre E (0,036) y S (0,022), y el tiempo a FGe < 30 ml/min. También se observa una relación estadísticamente significativa entre T1 y FGe < 30 ml/min. El análisis multivariante con la regresión de Cox para IgANPC y FGe <30 ml/min muestra una fuerte correlación (p = 0,016) entre el grupo de riesgo y FGe < 30 ml/min. CONCLUSIÓN: IgANP predice el tiempo hasta FGe < 30 ml/min y añade información independiente del MEST. La clasificación de MEST-C score y el IgANPC score son útiles e independientes para la predicción pronóstica; queda validar su uso en la población general
INTRODUCTION: IgA nephropathy (IgAN) is the most common and heterogeneous glomerular nephropathy. Several strategies have been used to determine the risk of progression to ESRD. We evaluate the prognostic significance and correlate the IgAN progression calculator (IgANPC) and the Oxford/MEST-C score in our population.MATERIAL AND METHODS: We performed a retrospective study of biopsied patients with diagnosis of IgA nephropathy from 1990 to 2015. We classified the biopsies using MEST-C score and we correlated the score to clinical evolution. We also calculated the risk of progression with the online IgANPC at the time of the biopsy. RESULTS: We analysed 48 biopsies, 83% of which were men with a mean age of 45 years at the time of the biopsy. Patients with a biopsy E1 according to MEST-C score had a higher IgANPC score than those with E0 (P = .021). The Pearson's correlation for the percentage of crescents and the IgANPC risk score was statistically significant (P = .014) with r = 0.357. The percentage of patients with eGFR above 30 ml/min at 10 years was 100% for the low-risk group (group 1 of IgANPC), and 0% for the high-risk group (group 3), log rank P = 0.001. The log rank comparison for variables of the MEST-C score, presented statistically significant results between E (0.036) and S (0.022) and the eGFR time < 30 ml/min. A statistically significant relationship was also observed between T1 and eGFR < 30 ml/min. The multivariate Cox regression analysis for IgANPC and eGFR < 30 ml/min demonstrated a strong correlation (P=.016) between the risk group and eGFR < 30 ml/min. CONCLUSION: In our study population, the IgANPC predicts the time to eGFR < 30 ml/min, and adds information independent of the MEST. The MEST-C classification and IgANPC are useful and independent ÿolos for prognostic prediction, but more studies are needed to validate its use in the general population
Assuntos
Humanos , Masculino , Adulto , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/patologia , Índice de Gravidade de Doença , Rim/patologia , Glomerulonefrite por IGA/fisiopatologia , Valor Preditivo dos Testes , Progressão da Doença , Biópsia , Estudos RetrospectivosRESUMO
INTRODUCTION: IgA nephropathy (IgAN) is the most common and heterogeneous glomerular nephropathy. Several strategies have been used to determine the risk of progression to ESRD. We evaluate the prognostic significance and correlate the IgAN progression calculator (IgANPC) and the Oxford/MEST-C score in our population. MATERIAL AND METHODS: We performed a retrospective study of biopsied patients with diagnosis of IgA nephropathy from 1990 to 2015. We classified the biopsies using MEST-C score and we correlated the score to clinical evolution. We also calculated the risk of progression with the online IgANPC at the time of the biopsy. RESULTS: We analysed 48 biopsies, 83% of which were men with a mean age of 45 years at the time of the biopsy. Patients with a biopsy E1 according to MEST-C score had a higher IgANPC score than those with E0 (P=.021). The Pearson's correlation for the percentage of crescents and the IgANPC risk score was statistically significant (P=.014) with r=0.357. The percentage of patients with eGFR above 30 ml/min at 10 years was 100% for the low-risk group (group 1 of IgANPC), and 0% for the high-risk group (group 3), log rank P=0.001. The log rank comparison for variables of the MEST-C score, presented statistically significant results between E (0.036) and S (0.022) and the eGFR time<30 ml/min. A statistically significant relationship was also observed between T1 and eGFR<30 ml/min. The multivariate Cox regression analysis for IgANPC and eGFR<30 ml/min demonstrated a strong correlation (P=.016) between the risk group and eGFR <30 ml/min. CONCLUSION: In our study population, the IgANPC predicts the time to eGFR<30 ml/min, and adds information independent of the MEST. The MEST-C classification and IgANPC are useful and independent ÿolos for prognostic prediction, but more studies are needed to validate its use in the general population.
