Hoshino et al reported a score for evaluating a renal biopsy from a patient with diabetes, the so-called D-score. This can help to identify a patient at risk for end-stage renal disease (ESRD). The authors are from Toranomon Hospital Kajigaya, Okinaka Memorial Institute and Yokohama City University in Kanagawa, Japan.
Patient selection: diabetes mellitus
Analysis: renal biopsy
Histologic parameters:
(1) glomerular pattern
(2) interstitial fibrosis and tubular atrophy (IFTA)
(3) interstitial inflammation
(4) hyalinosis
(5) arteriosclerosis
Parameter
Finding
Points
glomerular pattern
1
0
2A
3
2B
4
3
6
4
6
IFTA
0
0
1
7
2
9
3
11
interstitial inflammation
0
0
1
3
2
4
hyalinosis
0
0
1
0
2
3
arteriosclerosis
0
0
1
0
2
1
total D-score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 25
• The higher the score the greater the risk for end-stage renal disease (ESRD).
Score
10-Year Risk ESRD
<= 14
1
15 to 18
16.2
19 to 21
19.8
22 to 25
45.5
Performance:
• The area under the ROC curve is 0.83.
• A model including age, urine protein, eGFR and D-score had an area of 0.93.
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