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Validation of the Japanese histologic classification 2013 of immunoglobulin A nephropathy for prediction of long-term prognosis in a Japanese single-center cohort

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Abstract

Background

A new Japanese histologic classification (JHC) of immunoglobulin A nephropathy (IgAN) for prediction of long-term prognosis was proposed in 2013. The goal of this study was to validate the JHC system in a Japanese single-center cohort.

Methods

A retrospective study was conducted in 198 Japanese adult patients with IgAN. Clinical findings including blood pressure, urinary protein, estimated glomerular filtration rate (eGFR), and outcomes were evaluated in these patients. The glomerular lesion percentage score (GLPS) [number of glomeruli with cellular crescents, fibrocellular crescents, global sclerosis, segmental sclerosis, or fibrous crescents/number of total obtained glomeruli × 100 (%)] was assessed in each patient and categorized into histologic grades (HGs) of HG1 (<25 %), HG2 (25–49 %), and HG3/4 (≥50 %). Associations of GLPS (HG) with disease progression (50 % eGFR decline or end-stage renal disease requiring dialysis) within 10 years after biopsy and the rate of annual eGFR decline were examined.

Results

During a median follow-up period of 12.0 years after biopsy, disease progression occurred in 12.8 % (12/94) of HG1 patients, 32.3 % (21/65) of HG2 patients, and 46.2 % (18/39) of HG3/4 patients. The risk of disease progression was significantly higher in the HG2 and HG3/4 groups than in the HG1 group (odds ratios: 3.3 and 5.9 vs. 1). A higher GLPS was significantly associated with a higher risk of disease progression and a greater annual eGFR decline.

Conclusion

The newly proposed JHC system 2013 based on GLPS (HG) was well correlated with long-term prognosis in our cohort of Japanese adult patients with IgAN.

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Acknowledgments

The authors are grateful to all the doctors in our affiliated hospitals for referral of patients.

Conflict of interest

The authors have declared that no conflict of interest exists.

Author information

Author notes

  1. Ryuta Sato

    Present address: Division of Nephrology, Department of Internal Medicine, Jichi Medical University Graduate School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

Authors and Affiliations

  1. Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan

    Ryuta Sato, Atsushi Komatsuda, Shin Okuyama, Masaru Togashi, Ayumi Omokawa, Mizuho Nara, Ken-ichi Sawada & Hideki Wakui

  2. Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Kensuke Joh

  3. Department of Nephrology and Dialysis, Akita Kumiai General Hospital, Akita, Japan

    Hiroshi Ohtani

  4. Division of Nephrology, Department of Internal Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke, Tochigi, Japan

    Daisuke Nagata & Eiji Kusano

  5. Department of Internal Medicine, Utsunomiya Social Insurance Hospital, Utsunomiya, Tochigi, Japan

    Eiji Kusano

  6. Department of Life Science, Akita University Graduate School of Engineering and Resource Science, Akita, Japan

    Hideki Wakui

Authors
  1. Ryuta Sato
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  2. Kensuke Joh
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  3. Atsushi Komatsuda
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  4. Hiroshi Ohtani
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  5. Shin Okuyama
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  7. Ayumi Omokawa
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  8. Mizuho Nara
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  9. Daisuke Nagata
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  10. Eiji Kusano
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  11. Ken-ichi Sawada
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  12. Hideki Wakui
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Corresponding author

Correspondence to Ryuta Sato.

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Sato, R., Joh, K., Komatsuda, A. et al. Validation of the Japanese histologic classification 2013 of immunoglobulin A nephropathy for prediction of long-term prognosis in a Japanese single-center cohort. Clin Exp Nephrol 19, 411–418 (2015). https://doi.org/10.1007/s10157-014-1004-z

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  • DOI: https://doi.org/10.1007/s10157-014-1004-z

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