Alamartine studied factors associated with survival in patients with mesangial IgA glomerulonephritis (IgA nephropathy). These factors can help identify high risk patients so that they can receive closer monitoring and earlier interventions. The authors are from Saint-Etienne in France.
Parameters associated with survival as identified on multivariate analysis:
(1) global optical (histologic) score on the first renal biopsy: composed of subscores for mesangial lesions, tubular lesions, interstitial lesions, and vascular lesions
(2) amount of 24 hour proteinuria
(3) hypertension at presentation
(4) HLA-B35 antigen
|
Mesangial Lesions |
Finding |
Points |
|---|---|---|
|
mesangial proliferation |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
mesangial sclerosis |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
glomerular sclerosis |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
glomerular index =
= SUM(points for the 3 mesangial lesions)
|
Tubular Lesions |
Finding |
Points |
|---|---|---|
|
tubular atrophy |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
tubular necrosis |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
tubular index =
= SUM(points for the 2 tubular lesions)
|
Interstitial Lesions |
Finding |
Points |
|---|---|---|
|
interstitial cellular infiltrates |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
interstitial edema |
absent |
0 |
|
|
present |
1 |
|
interstitial sclerosis |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
interstitial index =
= SUM(points for the 3 mesangial lesions)
|
Vascular Lesions |
Finding |
Points |
|---|---|---|
|
subendothelial deposits |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
intimal proliferation |
absent |
0 |
|
|
mild-moderate |
1 |
|
|
marked |
2 |
|
vascular thrombosis |
absent |
0 |
|
|
present |
1 |
vascular index =
= SUM(points for the 3 mesangial lesions)
global optical score =
= (glomerular index) + (tubular index) + (interstitial index) + (vascular index)
with maximal global optical score = 20.
|
Parameter |
Finding |
Points |
|---|---|---|
|
24 hour proteinuria |
absent |
0 |
|
|
0 to 1 gram |
1 |
|
|
1.05 to 2 grams |
2 |
|
|
2.05 to 3 grams |
3 |
|
|
> 3 grams |
ROUNDUP(g,0) |
|
hypertension |
present at presentation |
1 |
|
|
absent at presentation |
0 |
|
HLA-B35 antigen |
present |
1 |
|
|
absent |
0 |
where:
• The scoring for proteinuria is that given on page 14, first column. However, in the Appendix on page 18 the example gives a 24 hour proteinuria of 1.5 grams/day 1 point. This might be an error in the Appendix, or I missed an adjustment.
X =
= (0.21 * (global optical score)) + (0.15 * (points for 24 hour proteinuria)) + (1.21 * (points for hypertension)) + (0.69 * (points for HLA-B35 antigen))
|
years from diagnosis |
baseline hazard rate |
|---|---|
|
0 |
0.02 |
|
5 |
0.05 |
|
10 |
0.10 |
|
15 |
0.19 |
|
20 |
0.29 |
h(t,Z) =
= (baseline hazard rate for t years) * EXP(X)
probability of survival at Y years =
= EXP((-1) * (baseline hazard rate for Y) * EXP(X))
Specialty: Nephrology, Clinical Laboratory, Immunology/Rheumatology
