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Prognostic significance of the extent of tubulointerstitial lesions in patients with IgA nephropathy

  • Nephrology - Original Paper
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Abstract

Purpose

IgA nephropathy (IgAN) is the most common type of primary glomerulonephritis worldwide. However, the effect of the degree of tubulointerstitial lesions (TIL) on the renal prognosis of these patients is uncertain.

Methods

All biopsy-proven primary IgAN patients from a single center (≥ 14 years old) were retrospectively examined from January 2006 to December 2011. According to the Oxford classification for tubulointerstitial lesions in IgAN, eligible patients were assigned to T0 or T1/2 groups. The clinicopathological features of these groups were compared and multivariate models were used to identify the effect of tubulointerstitial lesions on renal prognosis. The composite endpoint was end-stage renal disease or doubling of serum creatinine.

Results

We initially identified 1570 patients with IgAN and examined 988 patients who completed follow-up examinations (mean: 49 months). There were 506 patients in the T0 group (51.2%) and 482 in the T1/2 group (48.8%). The 1-year, 3-year, and 5-year incidences of the composite endpoint were 0.2%, 1.5%, 7.7% in the T0 group, and 1.9%, 9.9%, 18.1% in the T1/2 group. An adjusted multivariate model indicated the hazard ratio for reaching the composite endpoint was 9.3 for patients with T1/2 rather than T0 (reference group). A multivariate logistic analysis of the T1/2 group indicated the independent risk factors for reaching the composite endpoint were decreased eGFR, hypertension, hyperlipidemia, proteinuria, global glomerulosclerosis, and segmental glomerulosclerosis.

Conclusion

More severe tubulointerstitial lesions (> 25%, T1/2) were an independent predictor of poor renal prognosis in patients with IgAN.

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Availability of data and material

The datasets generated and analyzed in the present study are available from the corresponding author upon reasonable request.

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Acknowledgements

None.

Funding

This work was supported by grants from the Chinese National Key Technology R and D Program, Ministry of Science and Technology (No. 2017YFC0907601, No. 2017YFC0907602, and No. 2017YFC0907603, No. 2016YFC0906100, No. 2016YFC0906101); National Natural Science Foundation of China (No. 81970599 and No. 82170737); Natural Science Foundation of Guangdong Province (No. 2018A030313880); Guangzhou Municipal Program of Science and Technology (No. 201804020049); Key Laboratory of National Health Commission, and Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China (No. 2002B60118 and 2017B030314019, 2020B1212060028).

Author information

Author notes

  1. Xueqing Tang and Qiong Wen contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China

    Xueqing Tang, Qiong Wen, Qiongqiong Yang, Wei Chen & Xueqing Yu

  2. Key Laboratory of National Health Commission, Guangzhou, 510080, China

    Xueqing Tang, Qiong Wen, Qiongqiong Yang, Wei Chen & Xueqing Yu

  3. Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China

    Xueqing Tang, Qiong Wen, Qiongqiong Yang, Wei Chen & Xueqing Yu

  4. Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China

    Xueqing Tang

  5. Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China

    Qian Zhou

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  1. Xueqing Tang
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Contributions

TXQ, YQQ and CW conceived and designed research; TXQ and WQ collected data and conducted research; TXQ, WQ and ZQ analyzed and interpreted data; TXQ and WQ wrote the initial paper; CW and YXQ revised the paper; CW had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wei Chen.

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Conflict of interests

The authors have no financial interests or any conflicts of interest to disclose.

Ethics approval

This study was approved by the Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). All procedures performed in studies involving human participants were in accordance with the ethics standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards.

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Written informed consent was obtained from all individual participant or legal guardian included in the study.

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Tang, X., Wen, Q., Zhou, Q. et al. Prognostic significance of the extent of tubulointerstitial lesions in patients with IgA nephropathy. Int Urol Nephrol 55, 671–677 (2023). https://doi.org/10.1007/s11255-022-03286-2

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  • DOI: https://doi.org/10.1007/s11255-022-03286-2

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