A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study.
A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study.
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DOI：
10.1093/ndt/gfp273
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Tomino Y
中科院分区：
文献类型：
--
作者：
Goto M;Wakai K;Kawamura T;Ando M;Endoh M;Tomino Y
背景免疫球蛋白A肾病（IgAN）是肾小球肾炎的最常见形式，并且相当数量的患者死于终末期肾病（ESRD）。然而，预测个体患者的肾脏结局仍然很困难。我们已经发表了一个评分系统，使用的数据在一个前瞻性队列的IgAN患者随访1995年至2002年。方法.该队列在日本的97个临床单位进一步随访至2005年。采用考克斯回归分析2283例IgAN患者的资料，确定IgAN患者ESRD的预测因子，并将其β系数转换为评分，以估计10年内ESRD的风险。结果在随访期间（中位数，87个月），252例患者发展为ESRD。在多变量分析中，男性、年龄小于30岁、慢性肾衰竭和慢性肾小球肾炎家族史、高血压、蛋白尿、轻度血尿、低白蛋白血症、肾小球滤过率低和初次肾活检时组织学分级高与终末期肾病风险相关。采用单变量和多变量模型中的8个显著变量构建评分系统，以估计10年终末期肾病风险。该预后评分根据风险对患者进行了准确分类：估计值为0-4.9、5.0-19.9、20.0-49.9和50.0-100%的患者观察到的发生率分别为1.7、8.3、36.7和85.5%。相应的受试者工作特征曲线下面积为0.942（95%置信区间，0.925-0.958）。结论：在IgAN患者的10年随访中，这个经过验证的评分系统可以定量评估ESRD的风险，在临床实践中可以作为一个有用的预后工具。
Background. Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and a substantial number of patients succumb to end-stage renal disease (ESRD). However, prediction of the renal outcome in individual patients remains difficult. We have already published a scoring system using the data in a prospective cohort of IgAN patients followed up from 1995 to 2002. Methods. The cohort was further followed up until 2005 in 97 clinical units in Japan. The data from 2283 patients were analysed by Cox regression to determine the predictors of ESRD in IgAN, and their β-coefficients were converted into scores to estimate ESRD risk within 10 years. Results. During the follow-up (median, 87 months), 252 patients developed ESRD. Male sex, age less than 30 years, family histories of chronic renal failure and chronic glomerulonephritis, hypertension, proteinuria, mild haematuria, hypoalbuminaemia, low glomerular filtration rate and a high histological grade at initial renal biopsy were associated with the risk of ESRD in the multivariable analysis. A scoring system was framed to estimate the 10-year ESRD risk using eight variables significant in both univariable and multivariable models. This prognostic score accurately classified patients by risk: patients with estimates of 0–4.9, 5.0–19.9, 20.0–49.9 and 50.0–100% had an observed incidence of 1.7, 8.3, 36.7 and 85.5%, respectively. The corresponding area under the receiver-operating characteristic curve was 0.942 (95% confidence interval, 0.925–0.958). Conclusion. This validated scoring system to quantitatively estimate ESRD risk during the 10-year follow-up of IgAN patients will serve as a useful prognostic tool in clinical practice.
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