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Overweight and obesity accelerate the progression of IgA nephropathy: prognostic utility of a combination of BMI and histopathological parameters

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Abstract

Background

Although more than 40 years have passed since IgA nephropathy (IgAN) was first reported, predicting the renal outcome of individual IgAN patients remains difficult. Emerging epidemiologic evidence indicates that overweight and obesity are risk factors for end-stage renal disease. We aimed to elucidate the outcome of overweight IgAN patients and improve our ability to predict the progression of IgAN based on a combination of body mass index (BMI) and histopathological parameters, including maximal glomerular area (Max GA).

Methods

Forty-three adult IgAN patients whose estimated glomerular filtration rate was ≥50 ml/min/1.73 m2 were enrolled in this study. Renal biopsy specimens were evaluated according to the Oxford classification of IgAN. A Kaplan–Meier analysis and the multivariate Cox proportional hazards method were used to evaluate 10-year kidney survival and the impact of covariates. The ability of factors to predict the progression of IgAN was evaluated by their diagnostic odds ratio (DOR).

Results

A BMI ≥25 kg/m2 was found to be an independent predictor of a ≥1.5-fold increase in serum creatinine value (DOR 7.4). The combination of BMI ≥25 kg/m2, Max GA ≥42,900 μm2, and presence of mesangial hypercellularity (Oxford M1) optimally raised predictive power for disease progression of IgAN (DOR 26.0).

Conclusion

A combination of BMI ≥25 kg/m2, the Oxford classification M1, and a Max GA ≥42,900 μm2 can serve as a predictor of long-term renal outcome of IgAN.

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Acknowledgments

We would like to express our appreciation for providing us with statistical advice to Sadao Ishimura, Ph.D., D.Sc., Laboratory of Mathematics, Tsurumi University School of Dental Medicine, Yokohama, Japan.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Hiroshi Kataoka, Masayo Sato, Nobuyuki Amemiya & Kosaku Nitta

  2. Department of Nephrology, Kameda Medical Center, Chiba, Japan

    Mamiko Ohara, Kaori Shibui, Yoshihiko Watanabe & Takahiro Mochizuki

  3. National Hospital Organization, Chiba-East National Hospital, Chiba, Japan

    Tomo Suzuki

  4. Department of Pathology II, Tokyo Women’s Medical University, Tokyo, Japan

    Kazuho Honda

Authors
  1. Hiroshi Kataoka
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  2. Mamiko Ohara
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  3. Kaori Shibui
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  4. Masayo Sato
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  5. Tomo Suzuki
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  6. Nobuyuki Amemiya
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  7. Yoshihiko Watanabe
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  8. Kazuho Honda
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  9. Takahiro Mochizuki
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  10. Kosaku Nitta
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Corresponding author

Correspondence to Kosaku Nitta.

Appendix

Appendix

Terms used to evaluate a diagnostic test:

Sensitivity (Se): The proportion of positive test results among those with the target disease.

Specificity (Sp): The proportion of negative test results among those without the disease.

Positive predictive value (PPV): Probability of a disease being present in a patient with a positive test result.

Negative predictive value (NPV): Probability of a patient with a negative test result not having a disease.

Positive likelihood ratio (+LR): The ratio of evaluating how much more frequent a positive test is found in diseased versus non-diseased individuals.

Diagnostic odds ratio (DOR): A global measure of test performance calculated by using the formula: [Se/(1 − Sp)]/[(1 − Se)/Sp].

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Kataoka, H., Ohara, M., Shibui, K. et al. Overweight and obesity accelerate the progression of IgA nephropathy: prognostic utility of a combination of BMI and histopathological parameters. Clin Exp Nephrol 16, 706–712 (2012). https://doi.org/10.1007/s10157-012-0613-7

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  • DOI: https://doi.org/10.1007/s10157-012-0613-7

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