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A proposed Oxford classification-based clinicopathological nomogram for predicting short-term renal outcomes in IgA nephropathy after acute kidney injury

  • Author Footnotes
    1 These authors contributed to this study equally.
    Ling Zhang
    Correspondence
    Corresponding author at: Department of Geriatrics, the First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou 510080, China.
    Footnotes
    1 These authors contributed to this study equally.
    Affiliations
    Department of Geriatrics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed to this study equally.
    Xiaodong Zhuang
    Footnotes
    1 These authors contributed to this study equally.
    Affiliations
    Department of Cardiology, Key Laboratory of Assisted Circulation, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
    Search for articles by this author
  • Xinxue Liao
    Affiliations
    Department of Cardiology, Key Laboratory of Assisted Circulation, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed to this study equally.
Published:February 03, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.025

      Highlights

      • Studies on acute kidney injury (AKI) in the IgA nephropathy (IgAN) are limited.
      • We studied the effect of AKI on the progression of renal disease in IgAN patients.
      • IgAN patients with AKI had a poor survival outcome than those without AKI.
      • IgAN patients with AKI had 2.84 times higher risk of the composite renal endpoint.
      • A nomogram was developed for predicting the renal outcome in the IgAN patients.

      Abstract

      Background

      This study aimed to investigate the effect of acute kidney injury (AKI) on the progression of renal disease and to develop a clinico-pathological nomogram to predict the renal outcome of IgA nephropathy (IgAN) patients, based on Oxford classification score.

      Methods

      This is a retrospective observational study. A total of 988 IgAN patients treated at our hospital between 2006 and 2011 were included and divided into AKI (n = 82) and non-AKI group (n = 906). The primary outcome measure was the composite renal endpoint. The secondary outcome measure was all-cause mortality. Clinical and pathologic features were assessed with multivariable Cox regression to predict the outcome in IgAN patients. A nomogram was developed to predict the renal outcome.

      Results

      The median follow-up time was 48.6 months (range: 34.4 to 62.7). The incidence of AKI was 8.30%. The AKI group had more severe pathological characteristics and a significantly poor survival outcome than the non-AKI group. The multivariate Cox regression analysis showed that the AKI group had a 2.84 times higher risk of the composite renal endpoint as compared with the non-AKI group (P < 0.001). A clinico-pathological nomogram was developed using the seven predictors for the primary renal composite endpoint. The AUC for the nomogram model was 0.81 (sensitivity = 0.78, specificity = 0.85), and the C-index was 0.91 (95% CI = 0.85–0.97).

      Conclusions

      For IgAN patients, AKI is an independent risk factor for the progression of renal disease. Our nomogram model has good prediction power for the renal outcome of IgAN patients.

      Keywords

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      References

        • Makris K.
        • Spanou L.
        Acute kidney injury: definition, pathophysiology and clinical phenotypes.
        Clin Biochem Rev. 2016; 37: 85-98
        • Uchino S.
        • Bellomo R.
        • Goldsmith D.
        • Bates S.
        • Ronco C.
        An assessment of the RIFLE criteria for acute renal failure in hospitalized patients.
        Crit Care Med. 2006; 34: 1913
        • Thomas M.
        • Sitch A.
        • Dowswell G.
        The initial development and assessment of an automatic alert warning of acute kidney injury.
        Nephrol Dial Transplant. 2011; 26: 2161-2168
        • Hoste E.A.
        • Clermont G.
        • Kersten A.
        • Venkataraman R.
        • Angus D.C.
        • De Bacquer D.
        • et al.
        RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis.
        Crit Care. 2006; 10: R73
        • Xu X.
        • Nie S.
        • Liu Z.
        • Chen C.
        • Xu G.
        • Zha Y.
        • et al.
        Epidemiology and clinical correlates of AKI in Chinese hospitalized adults.
        Clin J Am Soc Nephrol. 2015; 10: 1510-1518
        • Yang L.
        • Xing G.
        • Wang L.
        • Wu Y.
        • Li S.
        • Xu G.
        • et al.
        Acute kidney injury in China: a cross-sectional survey.
        Lancet. 2015; 386: 1465-1471
        • Hsu C.Y.
        • McCulloch C.E.
        • Fan D.
        • Ordoñez J.D.
        • Chertow G.M.
        • Go A.S.
        Community-based incidence of acute renal failure.
        Kidney Int. 2007; 72: 208-212
        • Lafrance J.P.
        • Miller D.R.
        Acute kidney injury associates with increased long-term mortality.
        J Am Soc Nephrol. 2010; 21: 345-352
        • Xue J.L.
        • Daniels F.
        • Star R.A.
        • Kimmel P.L.
        • Eggers P.W.
        • Molitoris B.A.
        • et al.
        Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.
        J Am Soc Nephrol. 2006; 17: 1135-1142
        • Coca S.G.
        • Yusuf B.
        • Shlipak M.G.
        • Garg A.X.
        • Parikh C.R.
        Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis.
        Am J Kidney Dis. 2009; 53: 961-973
        • Coca S.G.
        • Singanamala S.
        • Parikh C.R.
        Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis.
        Kidney Int. 2012; 81: 442-448
        • D'Amico G.
        The commonest glomerulonephritis in the world: IgA nephropathy.
        Q J Med. 1987; 64: 709-727
      1. Nat Rev Dis Prim. 2016; 2: 16002
        • Li L.S.
        • Liu Z.H.
        Epidemiologic data of renal diseases from a single unit in China: analysis based on 13,519 renal biopsies.
        Kidney Int. 2004; 66: 920
        • Pan X.
        • Xu J.
        • Ren H.
        • Zhang W.
        • Xu Y.
        • Shen P.
        • et al.
        Changing spectrum of biopsy-proven primary glomerular diseases over the past 15 years: a single-center study in China.
        Contrib Nephrol. 2013; 181: 22-30
        • Zhou F.D.
        • Zhao M.H.
        • Zou W.Z.
        • Liu G.
        • Wang H.
        The changing spectrum of primary glomerular diseases within 15 years: a survey of 3331 patients in a single Chinese centre.
        Nephrol Dial Transplant. 2008; 24: 870-876
        • Moriyama T.
        • Tanaka K.
        • Iwasaki C.
        • Oshima Y.
        • Ochi A.
        • Kataoka H.
        • et al.
        Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan.
        PLoS One. 2014; 9e91756
        • Lv J.
        • Zhang H.
        • Zhou Y.
        • Li G.
        • Zou W.
        • Wang H.
        Natural history of immunoglobulin A nephropathy and predictive factors of prognosis: a long-term follow up of 204 cases in China.
        Nephrol Ther. 2008; 13: 242-246
        • Trimarchi H.
        • Barratt J.
        • Cattran D.C.
        • Cook H.T.
        • Coppo R.
        • Haas M.
        • et al.
        Oxford classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group.
        Kidney Int. 2017; 91: 1014-1021
        • Ge M.H.
        • Cao J.
        • Wang J.Y.
        • Huang Y.Q.
        • Lan X.-B.
        • Yu B.
        • et al.
        Nomograms predicting disease-specific regional recurrence and distant recurrence of papillary thyroid carcinoma following partial or total thyroidectomy.
        Medicine (Baltimore). 2017; 96: e7575
        • Shariat S.F.
        • Karakiewicz P.I.
        • Godoy G.
        • Lerner S.P.
        Use of nomograms for predictions of outcome in patients with advanced bladder cancer.
        Ther Adv Urol. 2009; 1: 13-26
        • Zhang L.
        • Li J.
        • Yang S.
        • Huang N.
        • Zhou Q.
        • Yang Q.
        • et al.
        Clinicopathological features and risk factors analysis of IgA nephropathy associated with acute kidney injury.
        Ren Fail. 2016; 38: 799-805
        • Bydash J.R.
        • Ishani A.
        Acute kidney injury and chronic kidney disease: a work in progress.
        Clin J Am Soc Nephrol. 2011; 6: 2555-2557
        • Lameire N.H.
        • Bagga A.
        • Cruz D.
        • De Maeseneer J.
        • Endre Z.
        • Kellum J.A.
        • et al.
        Acute kidney injury: an increasing global concern.
        Lancet (London, England). 2013; 382: 170-179
        • D'Amico G.
        • Colasanti G.
        • Barbiano di Belgioioso G.
        • Fellin G.
        • Ragni A.
        • Egidi F.
        • et al.
        Long-term follow-up of IgA mesangial nephropathy: clinico-histological study in 374 patients.
        Semin Nephrol. 1987; 7: 355-358
        • Weber C.L.
        • Rose C.L.
        • Magil A.B.
        Focal segmental glomerulosclerosis in mild IgA nephropathy: a clinical-pathologic study.
        Nephrol Dial Transplant. 2008; 24: 483-488
        • El Karoui K.
        • Hill G.S.
        • Karras A.
        • Moulonguet L.
        • Caudwell V.
        • Loupy A.
        • et al.
        Focal segmental glomerulosclerosis plays a major role in the progression of IgA nephropathy. II. Light microscopic and clinical studies.
        Kidney Int. 2011; 79: 643-654
        • Working Group of the International IgA Nephropathy Network and the Renal Pathology Society
        • ISD Roberts
        • Cook H.T.
        • Troyanov S.
        • Alpers C.E.
        • Amore A.
        • et al.
        The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility.
        Kidney Int. 2009; 76: 546-556
        • Rafieian-Kopaei M.
        • Baradaran A.
        • Nasri H.
        Significance of extracapillary proliferation in IgA-nephropathy patients with regard to clinical and histopathological variables.
        Hippokratia. 2013; 17: 258-261
        • Walsh M.
        • Sar A.
        • Lee D.
        • Yilmaz S.
        • Benediktsson H.
        • Manns B.
        • et al.
        Histopathologic features aid in predicting risk for progression of IgA nephropathy.
        Clin J Am Soc Nephrol. 2010; 5: 425-430
        • Katafuchi R.
        • Ninomiya T.
        • Nagata M.
        • Mitsuiki K.
        • Hirakata H.
        Validation study of oxford classification of IgA nephropathy: the significance of extracapillary proliferation.
        Clin J Am Soc Nephrol. 2011; 6: 2806-2813
        • Haas M.
        • Verhave J.C.
        • Liu Z.-H.
        • Alpers C.E.
        • Barratt J.
        • Becker J.U.
        • et al.
        A multicenter study of the predictive value of crescents in IgA nephropathy.
        J Am Soc Nephrol. 2017; 28: 691-701
        • Lee H.
        • Yi S.H.
        • Seo M.S.
        • Hyun J.N.
        • Jeon J.S.
        • Noh H.
        • et al.
        Validation of the Oxford classification of IgA nephropathy: a single-center study in Korean adults.
        Korean J Intern Med. 2012; 27: 293
        • Lee M.J.
        • Kim S.J.
        • Oh H.J.
        • Ko K.I.
        • Koo H.M.
        • Kim C.H.
        • et al.
        Clinical implication of crescentic lesions in immunoglobulin A nephropathy.
        Nephrol Dial Transplant. 2014; 29: 356-364
        • Lv J.
        • Yang Y.
        • Zhang H.
        • Chen W.
        • Pan X.
        • Guo Z.
        • et al.
        Prediction of outcomes in crescentic IgA nephropathy in a multicenter cohort study.
        J Am Soc Nephrol. 2013; 24: 2118-2125
        • Barbour S.J.
        • Espino-Hernandez G.
        • Reich H.N.
        • Coppo R.
        • Roberts I.S.D.
        • Feehally J.
        • et al.
        The MEST score provides earlier risk prediction in lgA nephropathy.
        Kidney Int. 2016; 89: 167-175
        • Coppo R.
        • Fervenza F.C.
        Persistent microscopic hematuria as a risk factor for progression of IgA nephropathy: new floodlight on a nearly forgotten biomarker.
        J Am Soc Nephrol. 2017; 28: 2831-2834