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Maximum Glomerular Diameter and Oxford MEST-C Score in IgA Nephropathy: The Significance of Time-Series Changes in Pseudo-R2 Values in Relation to Renal Outcomes

1
Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-866, Japan
2
Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-866, Japan
3
Department of Nephrology, Kameda Medical Center, Chiba 296-8602, Japan
4
Department of Pathology II, Tokyo Women’s Medical University, Tokyo 162-866, Japan
5
Department of Anatomy, Showa University, Tokyo 142-8555, Japan
6
Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-866, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2105; https://doi.org/10.3390/jcm8122105
Received: 17 October 2019 / Revised: 21 November 2019 / Accepted: 21 November 2019 / Published: 2 December 2019
(This article belongs to the Section Nephrology & Urology)
The progression of immunoglobulin A nephropathy (IgAN) is currently assessed using the Oxford MEST-C score, which uses five indicators (mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and the presence of crescents) but has not yet included any risk factors related to glomerular size. Therefore, we tested whether adding another indicator, maximal glomerular diameter (Max GD), would improve the prognostic ability of this scoring system. The data of 101 adult patients diagnosed with IgAN between March 2002 and September 2004 were reviewed. We used McFadden’s pseudo-R2 and the corrected Akaike information criterion to assess model fit and the concordance (C)-statistic to assess discriminatory ability. A 10 μm increase in Max GD was significantly associated with a composite outcome (≥50% decline in the estimated glomerular filtration rate or end-stage renal disease). The receiver operating characteristic analysis determined the cut-off for high vs. low Max GD at 245.9 μm, and adding high Max GD to the MEST-C score significantly improved the model’s discrimination of renal outcomes at 5 and ≥10 years. Thus, including the Max GD in the Oxford classification of IgAN might increase its robustness and provide a more comprehensive prognostic system for clinical settings. View Full-Text
Keywords: immunoglobulin a nephropathy; Oxford MEST-C score; glomerular hypertrophy; prognosis; pseudo-R2; renal biopsy immunoglobulin a nephropathy; Oxford MEST-C score; glomerular hypertrophy; prognosis; pseudo-R2; renal biopsy
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Kataoka, H.; Moriyama, T.; Manabe, S.; Kawachi, K.; Ushio, Y.; Watanabe, S.; Akihisa, T.; Makabe, S.; Sato, M.; Iwasa, N.; Sawara, Y.; Ohara, M.; Taneda, S.; Uchida, K.; Honda, K.; Mochizuki, T.; Tsuchiya, K.; Nitta, K. Maximum Glomerular Diameter and Oxford MEST-C Score in IgA Nephropathy: The Significance of Time-Series Changes in Pseudo-R2 Values in Relation to Renal Outcomes. J. Clin. Med. 2019, 8, 2105.

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