Significance of the total renal chronicity score in predicting renal outcome in PLA2R-associated membranous nephropathy.

Abstract

Phospholipase A2 receptor (PLA2R)-associated membranous nephropathy accounts for the majority of membranous nephropathy; however, few studies have determined the prognostic impact and clinicalapplication of renal pathologic change on this disease. A retrospective cohort study of 262 patients with PLA2R-associated membranous nephropathy was conducted. The total renal chronicity score calculatedaccording to the degree ofglomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriosclerosis was applied to evaluate renal chronicity. Baseline bias was adjusted by inverse probability weight whenassessing the prognostic impact of chronicity, and multiple parameters were used to evaluatethe application valueof renalchronicity. During a median follow-up of 24.5 months, renal outcome (kidney function deteriorationand/or end-stage kidney disease) was observed in 22 (8.40%) patients. Not only did a higher total renal chronicity score independently predict renal outcome [odds ratio (OR): 1.562, 95% confidence interval (CI) 1.073-2.273, P = 0.020], but non-minimal chronicity was also an independent risk factor for renal outcome (OR: 3.170, 95% CI 1.040-9.659, P = 0.042). Moreover, the membranous nephropathy risk classification in the Kidney Disease: Improving Global Outcomes (KDIGO) guideline integrated with non-minimal chronicity showed improvements in categorical net reclassification (0.174, 95% CI 0.012-0.335, P = 0.035), continuous net reclassification (0.462, 95% CI 0.087-0.838, P = 0.016), and integrated discrimination (0.019, 95% CI 0.003-0.035, P = 0.020) compared to the original classification. Renal chronicity is closely associated withrenal outcomes in PLA2R-associated membranous nephropathy, and combiningthe KDIGO risk classification with chronicity scoresmay provide amore accurate prognostic prediction.