Jingying Tu, Xiaoqian Chen, Haichun Yang, Yiqin Zuo, Fanfan Li, Ji Zhang, Bo Chen, Yinqiu Lv, Chaosheng Chen, Zhen Su, Duo Li
{"title":"Impact of intrarenal arterial lesions on prognosis of IgA nephropathy: insights from a retrospective cohort study.","authors":"Jingying Tu, Xiaoqian Chen, Haichun Yang, Yiqin Zuo, Fanfan Li, Ji Zhang, Bo Chen, Yinqiu Lv, Chaosheng Chen, Zhen Su, Duo Li","doi":"10.1080/0886022X.2025.2476052","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>IgA nephropathy (IgAN) presents a challenging spectrum of outcomes, often complicated by intrarenal arterial/arteriolar lesions (IALs) in affected individuals. Despite their clinical relevance, existing criteria for classifying and assessing the severity of these lesions remain undefined. This study aimed to establish semi-quantitative assessment criteria for grading IALs and to evaluate their prognostic significance in patients with IgAN.</p><p><strong>Method: </strong>We conducted a retrospective cohort study of 417 cases of primary IgAN in which IALs were meticulously scored in individual biopsies. Kaplan-Meier survival analysis was employed to compare the time to the renal composite endpoint between different IALs severity groups. The association between the severity of IALs and clinical outcomes was further evaluated using multivariate Cox regression models to control for potential confounders.</p><p><strong>Results: </strong>Among the 417 patients studied, 230 (55.2%) exhibited IALs. Kaplan-Meier curve analysis showed a higher cumulative incidence of the composite endpoint in patients with IALs (<i>p</i> < 0.001). In a compelling multivariate analysis, we identified IALs and its subclassifications, including moderate to severe intimal fibrosis and hyalinosis, as strong independent risk factors for poor prognosis (IALs: HR = 2.15, <i>p</i> = 0.009; moderate to severe hyalinosis: HR = 3.58, <i>p</i> = 0.001; moderate to severe intimal fibrosis: HR = 3.56, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Our findings underscore the prognostic significance of IALs in IgAN, particularly moderate to severe intimal fibrosis and hyalinosis and highlight the urgent need for novel therapeutic strategies specifically designed to mitigate the impact of IALs in high-risk IgAN patients.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2476052"},"PeriodicalIF":3.0000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905313/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2025.2476052","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: IgA nephropathy (IgAN) presents a challenging spectrum of outcomes, often complicated by intrarenal arterial/arteriolar lesions (IALs) in affected individuals. Despite their clinical relevance, existing criteria for classifying and assessing the severity of these lesions remain undefined. This study aimed to establish semi-quantitative assessment criteria for grading IALs and to evaluate their prognostic significance in patients with IgAN.
Method: We conducted a retrospective cohort study of 417 cases of primary IgAN in which IALs were meticulously scored in individual biopsies. Kaplan-Meier survival analysis was employed to compare the time to the renal composite endpoint between different IALs severity groups. The association between the severity of IALs and clinical outcomes was further evaluated using multivariate Cox regression models to control for potential confounders.
Results: Among the 417 patients studied, 230 (55.2%) exhibited IALs. Kaplan-Meier curve analysis showed a higher cumulative incidence of the composite endpoint in patients with IALs (p < 0.001). In a compelling multivariate analysis, we identified IALs and its subclassifications, including moderate to severe intimal fibrosis and hyalinosis, as strong independent risk factors for poor prognosis (IALs: HR = 2.15, p = 0.009; moderate to severe hyalinosis: HR = 3.58, p = 0.001; moderate to severe intimal fibrosis: HR = 3.56, p = 0.001).
Conclusion: Our findings underscore the prognostic significance of IALs in IgAN, particularly moderate to severe intimal fibrosis and hyalinosis and highlight the urgent need for novel therapeutic strategies specifically designed to mitigate the impact of IALs in high-risk IgAN patients.
背景:IgA肾病(IgAN)呈现出具有挑战性的预后谱,患者通常并发肾内动脉/小动脉病变(ial)。尽管其临床相关性,现有的分类和评估这些病变严重程度的标准仍然不明确。本研究旨在建立半定量的ial分级评估标准,并评估其在IgAN患者中的预后意义。方法:我们对417例原发性IgAN进行了回顾性队列研究,并在个体活检中对其进行了精心评分。采用Kaplan-Meier生存分析比较不同ial严重程度组之间到达肾脏复合终点的时间。使用多变量Cox回归模型进一步评估ial严重程度与临床结果之间的关系,以控制潜在的混杂因素。结果:在417例患者中,230例(55.2%)出现als。Kaplan-Meier曲线分析显示,ial患者复合终点的累积发生率较高(p p = 0.009;中度至重度透明质病:HR = 3.58, p = 0.001;中度至重度内膜纤维化:HR = 3.56, p = 0.001)。结论:我们的研究结果强调了ial在IgAN中的预后意义,特别是中度至重度内膜纤维化和透明质病,并强调了迫切需要专门设计的新型治疗策略来减轻ial对高风险IgAN患者的影响。
期刊介绍:
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.