Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/3514367

In Collections

This item can be found in the following collections:

Lomax-Browne, H.J.; Medjeral-Thomas, N.R.; Barbour, S.J.; Gisby, J.; Han, H.; Bomback, A.S.; ... ; Pickering, M.C. (2022)

Association of histologic parameters with outcome in C3 glomerulopathy and idiopathic immunoglobulin-associated membranoproliferative glomerulonephritis

Article / Letter to editor
Background and objectives: C3 glomerulopathy and idiopathic Ig-associated membranoproliferative GN are kidney diseases characterized by abnormal glomerular complement C3 deposition. These conditions are heterogeneous in outcome, but approximately 50% of patients develop kidney failure within 10 years. Design, setting, participants, & measurements: To improve identification of patients with poor prognosis, we performed a detailed analysis of percutaneous kidney biopsies in a large cohort of patients. Using a validated histologic scoring system, we analyzed 156 native diagnostic kidney biopsies from a retrospective cohort of 123patients with C3 glomerulopathy and 33 patients with Ig-associated membranoproliferative GN. We used linear regression, survival analysis, and Cox proportional hazards models to assess the relationship between histologic and clinical parameters with outcome. Results: Frequent biopsy features were mesangial expansion and hypercellularity, glomerular basement...Show moreBackground and objectives: C3 glomerulopathy and idiopathic Ig-associated membranoproliferative GN are kidney diseases characterized by abnormal glomerular complement C3 deposition. These conditions are heterogeneous in outcome, but approximately 50% of patients develop kidney failure within 10 years. Design, setting, participants, & measurements: To improve identification of patients with poor prognosis, we performed a detailed analysis of percutaneous kidney biopsies in a large cohort of patients. Using a validated histologic scoring system, we analyzed 156 native diagnostic kidney biopsies from a retrospective cohort of 123patients with C3 glomerulopathy and 33 patients with Ig-associated membranoproliferative GN. We used linear regression, survival analysis, and Cox proportional hazards models to assess the relationship between histologic and clinical parameters with outcome. Results: Frequent biopsy features were mesangial expansion and hypercellularity, glomerular basement membrane double contours, and endocapillary hypercellularity. Multivariable analysis showed negative associations between eGFR and crescents, interstitial inflammation, and interstitialfibrosis/tubular atrophy. Proteinuria positively associated with endocapillary hypercellularity and glomerular basement membrane double contours. Analysis of second native biopsies did not demonstrate associations between immunosuppression treatment and improvement in histology. Using a composite outcome, risk of progression to kidney failure associated with eGFR and proteinuria at the time of biopsy, cellular/fibrocellular crescents, segmental sclerosis, and interstitial fibrosis/tubular atrophy scores. Conclusions: Our detailed assessment of kidney biopsy data indicated that cellular/fibrocellular crescents and interstitial fibrosis/tubular atrophy scores were significant determinants of deterioration in kidney function.Show less
glomerulonephritis
complement
kidney biopsy
membranoproliferative glomerulonephritis (MPGN)
All authors
Lomax-Browne, H.J.; Medjeral-Thomas, N.R.; Barbour, S.J.; Gisby, J.; Han, H.; Bomback, A.S.; Fervenza, F.C.; Cairns, T.H.; Szydlo, R.; Tan, S.J.; Marks, S.D.; Waters, A.M.; Appel, G.B.; D'Agati, V.D.; Sethi, S.; Nast, C.C.; Bajema, I.; Alpers, C.E.; Fogo, A.B.; Licht, C.; Fakhouri, F.; Cattran, D.C.; Peters, J.E.; Cook, H.T.; Pickering, M.C.
Date
2022-06-29
Journal
Clinical Journal of the American Society of Nephrology
Volume
17
Issue
7
Pages
994 - 1007
DOI
doi:10.2215/CJN.16801221