CHRONICITY SCORE AND NOT MEST C SCORE IS A BETTER PREDICTOR OF PROGNOSIS IN IGA NEPHROPATHY

Introduction:

IgA nephropathy is one of the leading cause of end stage kidney disease in Asians. IgAN has a varied presentation across different geographical region and races. Asians are known to have more aggressive and unpredictable clinical course.

Methods:

Biopsy proven IgA nephropathy cohort of Dr. Vidya N. Acharya Glomeronephritis Registry of K.E.M Hospital, Mumbai since January 2019 to July 2024 with minimum 6 months duration of follow up were studied. Chronicity score was calculated using parameters of glomerular sclerosis, interstitial fibrosis, tubular atrophy and arteriosclerosis on kidney biopsy, and was graded into minimal, mild, moderate and severe. Primary outcome was composite of death and dialysis. Analyses of poor outcome were conducted using Kaplan-Meier and Cox regression.

Results:

Of 66 total patients of IgAN, 57.5% were male. Mean age was 41 ± 18.5 years. Mean GFR and proteinuria at presentation was 47.11 ± 35.4 ml/min/1.73m2 and 4 ± 4.1 g/day respectively. The mean duration of symptom onset to biopsy was 7.1 ± 1.3 months. The commonest presentation was Nephrotic nephritic syndrome seen in 24/66 (36.3%) and 9/66 (13.6%) presented as rapidly progressive kidney failure. Gross hematuria, hypertension and IgA vasculitis was seen in 27.27% (18/66), 65.1% (43/66) and 9/66 (13.6%) patients respectively. 8/66 (12.1%) were lost to follow up. 16/58 (27.2%) and 12/58 (20.6%) patients achieved complete and partial remission respectively. Dialysis, 50% reduction in GFR and deaths were seen in 15/58 (25.8%), 5/58 (8.6%) 9/58 (15.5%) patients respectively. Mean duration of follow up was 7.7 ± 10.5 months. MEST C score was not helpful in predicting poor outcomes. Presence of severe or malignant hypertension (p=0.042) and higher chronicity score (p=0.000) were found to be predictors for the need of dialysis or death. Presence of IgA vasculitis indicated better prognosis (p=0.029).

(A)

(B)

(C) .                                                                                                                                               Kaplan-Meier and Cox regression analysis for predictors of  primary outcomes with respect to A) Chronicity grading score B) Severe or malignant hypertension C) IgA vasculitis

Conclusions:

Higher chronicity score and presence of severe hypertension predicted poor outcomes in our cohort of IgAN.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.