PLoS ONE (Jan 2018)

A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy.

  • Junichi Hoshino,
  • Kengo Furuichi,
  • Masayuki Yamanouchi,
  • Koki Mise,
  • Akinari Sekine,
  • Masahiro Kawada,
  • Keiichi Sumida,
  • Rikako Hiramatsu,
  • Eiko Hasegawa,
  • Noriko Hayami,
  • Tatsuya Suwabe,
  • Naoki Sawa,
  • Shigeko Hara,
  • Takeshi Fujii,
  • Kenichi Ohashi,
  • Kiyoki Kitagawa,
  • Tadashi Toyama,
  • Miho Shimizu,
  • Kenmei Takaichi,
  • Yoshifumi Ubara,
  • Takashi Wada

DOI
https://doi.org/10.1371/journal.pone.0190923
Journal volume & issue
Vol. 13, no. 2
p. e0190923

Abstract

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The impact of the newly proposed pathological classification by the Japan Renal Pathology Society (JRPS) on renal outcome is unclear. So we evaluated that impact and created a new pathological scoring to predict outcome using this classification.A multicenter cohort of 493 biopsy-proven Japanese patients with diabetic nephropathy (DN) were analyzed. The association between each pathological factor-Tervaert' and JRPS classifications-and renal outcome (dialysis initiation or 50% eGFR decline) was estimated by adjusted Cox regression. The overall pathological risk score (J-score) was calculated, whereupon its predictive ability for 10-year risk of renal outcome was evaluated.The J-scores of diffuse lesion classes 2 or 3, GBM doubling class 3, presence of mesangiolysis, polar vasculosis, and arteriolar hyalinosis were, respectively, 1, 2, 4, 1, and 2. The scores of IFTA classes 1, 2, and 3 were, respectively, 3, 4, and 4, and those of interstitial inflammation classes 1, 2, and 3 were 5, 5, and 4 (J-score range, 0-19). Renal survival curves, when dividing into four J-score grades (0-5, 6-10, 11-15, and 16-19), were significantly different from each other (p<0.01, log-rank test). After adjusting clinical factors, the J-score was a significant predictor of renal outcome. Ability to predict 10-year renal outcome was improved when the J-score was added to the basic model: c-statistics from 0.661 to 0.685; category-free net reclassification improvement, 0.154 (-0.040, 0.349, p = 0.12); and integrated discrimination improvement, 0.015 (0.003, 0.028, p = 0.02).Mesangiolysis, polar vasculosis, and doubling of GBM-features of the JRPS system-were significantly associated with renal outcome. Prediction of DN patients' renal outcome was better with the J-score than without it.