A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy

作者：Hoshino Junichi^*; Furuichi Kengo; Yamanouchi Masayuki; Mise Koki; Sekine Akinari; Kawada Masahiro; Sumida Keiichi; Hiramatsu Rikako; Hasegawa Eiko; Hayami Noriko; Suwabe Tatsuya; Sawa Naoki; Hara Shigeko; Fujii Takeshi; Ohashi Kenichi; Kitagawa Kiyoki; Toyama Tadashi; Shimizu Miho; Takaichi Kenmei; Ubara Yoshifumi; Wada Takashi

来源：PLos One, 2018, 13(2): e0190923.

DOI：10.1371/journal.pone.0190923

Background and objectives
The impact of the newly proposed pathological classification by the Japan Renal Pathology Society (JRPS) on renal outcome is unclear. So we evaluated that impact and created a new pathological scoring to predict outcome using this classification.
Design, setting, participants, & measurements
A multicenter cohort of 493 biopsy-proven Japanese patients with diabetic nephropathy (DN) were analyzed. The association between each pathological factor-Tervaert' and JRPS classifications-and renal outcome (dialysis initiation or 50% eGFR decline) was estimated by adjusted Cox regression. The overall pathological risk score (J-score) was calculated, whereupon its predictive ability for 10-year risk of renal outcome was evaluated.
Results
The J-scores of diffuse lesion classes 2 or 3, GBM doubling class 3, presence of mesangiolysis, polar vasculosis, and arteriolar hyalinosis were, respectively, 1, 2, 4, 1, and 2. The scores of IFTA classes 1, 2, and 3 were, respectively, 3, 4, and 4, and those of interstitial inflammation classes 1, 2, and 3 were 5, 5, and 4 (J-score range, 0-19). Renal survival curves, when dividing into four J-score grades (0-5, 6-10, 11-15, and 16-19), were significantly different from each other (p<0.01, log-rank test). After adjusting clinical factors, the J-score was a significant predictor of renal outcome. Ability to predict 10-year renal outcome was improved when the J-score was added to the basic model: c-statistics from 0.661 to 0.685; category-free net reclassification improvement, 0.154 (-0.040, 0.349, p = 0.12); and integrated discrimination improvement, 0.015 (0.003, 0.028, p = 0.02).
Conclusions
Mesangiolysis, polar vasculosis, and doubling of GBM-features of the JRPS system-were significantly associated with renal outcome. Prediction of DN patients' renal outcome was better with the J-score than without it.

• 出版日期2018-2-6
• 单位河北医科大学