Back
IgA nephropathy (IgAN) is the most common primary glomerulopathy biopsied worldwide. In the Mexican population, it is underestimated by the few reference centers for diagnosis of glomerular diseases. The objective of our study was to identify the association of glomerular syndromes with histological findings according to the MEST-C score of the Oxford classification in patients with IgA nephropathy.
Retrospective, observational, cohort in patients diagnosed by renal biopsy with IgA nephropathy treated in the nephrology service at the Specialty Hospital of the La Raza National Medical Center. Patients were grouped according to glomerular syndrome at the time of biopsy. For the analysis, descriptive statistics, odds ratio (OR) with a 95% confidence interval were used to determine the association of glomerular syndromes and histological findings using the MEST-C scheme of the Oxford classification.
Endocapillary hypercellularity, although observed in half of the patients, was not associated with any glomerular syndrome. For its part, the absence of segmental sclerosis (S0) was associated with an increased risk of developing hematuria-proteinuria syndrome (OR: 2,500 95% CI: 1,613-3,875). The finding of Tubular Atrophy with Interstitial Fibrosis T0 and the absence of C0 cellular/fibrocellular crescents were associated with a decreased risk of developing rapidly progressive syndrome with OR: 0.111 and 95% CI: 0.018-0.705 and OR: 0.143 with 95% CI: 0.023 -0.899, respectively. In contrast, Tubular Atrophy with T2 Interstitial Fibrosis and the presence of C2 cellular/fibrocellular crescents were associated with an increased risk of developing rapidly progressive syndrome with OR: 5,800 and 95%CI: 2,613-12,874 and OR: 4,429 with 95%CI : 2,308-8,499, respectively. Additionally, the presence of cellular/fibrocellular crescents was associated with an increased risk of presenting hematuria (OR: 1.292 with 95% CI: 1.068-1.562), hematuria-proteinuria syndrome (OR: 2.385 with 95% CI: 1.576-3.608) and nephrotic syndrome (OR: 5,167 with 95% CI: 2,519-10,599).
The presence of crescents was associated with an increased risk of developing hematuria and hematuria-proteinuria syndrome. Finding tubulo-interstitial fibrosis greater than 50% of the cortical area, as well as the finding of >25% of glomeruli with crescents, were associated with an increased risk of developing rapidly progressive syndrome, highlighting the prognosis importance of the MEST-C score of the Oxford classification and the importance of improving activity markers.