MEST-C评分的盲点:IgA肾病小管间质性肾炎的类型和严重程度。

IF 1.7 Q3 UROLOGY & NEPHROLOGY
Iram Asrar, Mudassar Hussain, Aurangzeb Afzal, Usman Hassan, Sheeba Ishtiaq
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引用次数: 2

摘要

背景:免疫球蛋白A肾病(IgAN)预后预测分类的最新版本“牛津分类”确定了五种组织病理学特征,包括系膜细胞增多(M)、毛细血管内增生(E)、节段性肾小球硬化(S)、小管萎缩/间质纤维化(T)和新月状(C),即MEST-C。然而,很少有研究表明,未包括在MEST-C中的小管间质炎症也与疾病进展有关,因此是一个被忽视的预后决定因素。因此,有必要对IgA肾病患者的这一组织病理学参数进行评估。材料和方法:本横断面描述性研究在巴基斯坦拉合尔的Shaukat Khanum纪念癌症医院和研究中心进行。使用方便的采样技术提取2016年1月至2022年5月IgA肾病患者(300例)的组织病理学和免疫荧光证实的肾活检数据。除MEST-C评分外,组织学检查活检以确定小管间质炎症的类型和严重程度。排除有移植史、组织自溶、组织学检查无肾小球和/或MEST-C评分为2 (T2)的肾活检患者。数据采用SPSS 20进行分析。使用卡方检验和费舍尔精确检验分析变量之间的关联。p值小于0.05认为有统计学意义。结果:共有247/300例活检符合纳入条件。活检时的平均年龄为31.90±12.48岁,21 ~ 40岁年龄组占63.6%,男性占69.6%。90.2%的患者出现了小管间质性炎症,其中49.4%为中度炎症,4.5%为重度炎症。小管间质炎症的类型和严重程度与M、E、T和C评分有很强的相关性(p值< 0.05)。结论:在我们的研究中,小管间质炎症与M、E、T和C评分之间高频且强的统计学关联阐明了其在IgA肾病进展和治疗中的预后作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Blind Spot in the Radar of MEST-C Score: Type and Severity of Tubulointerstitial Nephritis in IgA Nephropathy.

Blind Spot in the Radar of MEST-C Score: Type and Severity of Tubulointerstitial Nephritis in IgA Nephropathy.

Background: The updated version of predictive classification for immunoglobulin A nephropathy (IgAN) prognosis "The Oxford Classification" identifies five histopathological features including mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C), the MEST-C. However, few studies suggest that tubulointerstitial inflammation, which is not included in the MEST-C, is also linked to disease progression and is, consequently, a neglected determinant of prognosis among others. Therefore, there is a need to evaluate this histopathological parameter in patients with IgA nephropathy.

Materials and methods: This cross-sectional descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Data of histopathological and immunofluorescence proven renal biopsies (300) of IgA nephropathy patients from January 2016 through May 2022 were extracted using a convenient sampling technique. Biopsies were histologically reviewed for type and severity of tubulointerstitial inflammation, in addition to the MEST-C score. Renal biopsies of patients who had a history of transplant, autolyzed tissue, no glomeruli on histological examination, and/or a tubular atrophy/interstitial fibrosis score of 2 (T2) in MEST-C scoring were excluded. Data were analyzed using SPSS 20. An association between the variables was analyzed using the chi-square and Fischer exact tests. A p value less than 0.05 was considered statistically significant.

Results: A total of 247/300 biopsies were eligible for inclusion. The mean age at the time of biopsy was 31.90 ± 12.48 with 63.6% in the age group between 21 and 40 years, and 69.6% were male. Tubulointerstitial inflammation was observed in 90.2% cases with 49.4% showing moderate while 4.5% showing severe degree of inflammation. A strong association of both the type and severity of tubulointerstitial inflammation was found with M, E, T, and C scores (p value < 0.05).

Conclusion: The high-frequency and strong statistical association of tubulointerstitial inflammation with the M, E, T, and C scores in our study elucidate its prognostic role in the progression and management of IgA nephropathy.

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来源期刊
International Journal of Nephrology
International Journal of Nephrology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
4.80%
发文量
44
审稿时长
17 weeks
期刊介绍: International Journal of Nephrology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders. The journal welcomes submissions related to cell biology, developmental biology, genetics, immunology, pathology, pathophysiology of renal disease and progression, clinical nephrology, dialysis, and transplantation.
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