TY - JOUR
T1 - The MEST score provides earlier risk prediction in lgA nephropathy
AU - Barbour, Sean J.
AU - Espino-Hernandez, Gabriela
AU - the Oxford Derivation, North American Validation and VALIGA Consortia
AU - Reich, Heather N.
AU - Coppo, R.
AU - Roberts, Ian S.D.
AU - Feehally, John
AU - Herzenberg, Andrew M.
AU - Cattran, D. C.
AU - Bavbek, N.
AU - Cook, T.
AU - Troyanov, S.
AU - Alpers, C.
AU - Amore, A.
AU - Barratt, J.
AU - Berthoux, F.
AU - Bonsib, S.
AU - Bruijn, J.
AU - D'Agati, V.
AU - D'Amico, G.
AU - Emancipator, S.
AU - Emmal, F.
AU - Ferrario, F.
AU - Fervenza, F.
AU - Florquin, S.
AU - Fogo, A.
AU - Geddes, C.
AU - Groene, H.
AU - Haas, M.
AU - Hill, P.
AU - Hogg, R.
AU - Hsu, S.
AU - Hunley, T.
AU - Hladunewich, M.
AU - Jennette, C.
AU - Joh, K.
AU - Julian, B.
AU - Li, L.
AU - Li, P.
AU - Liu, Z.
AU - Wang, H.
AU - Weening, J.
AU - Zhang, H.
AU - Pugliese, F.
AU - Peters, H.
AU - Martin, C.
AU - Van Kooten, C.
AU - Reinders, M. E.J.
AU - Gutiérrez, E.
AU - Steenbergen, E.
AU - Bruijn, J.
N1 - Publisher Copyright:
© 2015 International Society of Nephrology.
PY - 2016/1
Y1 - 2016/1
N2 - The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.
AB - The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.
UR - http://www.scopus.com/inward/record.url?scp=84945559550&partnerID=8YFLogxK
U2 - 10.1038/ki.2015.322
DO - 10.1038/ki.2015.322
M3 - Article
C2 - 26759049
AN - SCOPUS:84945559550
SN - 0085-2538
VL - 89
SP - 167
EP - 175
JO - Kidney International
JF - Kidney International
IS - 1
ER -