Prognostic Factors and Validation of the Histologic Chronicity Score for C3 Glomerulopathy: a Registry Analysis

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2024 Oct 18

PMID 39421234

Authors

Safak Mirioglu

Egemen Cebeci

Halil Yazici

Ulver Derici

Gulizar Sahin

Ganime Coban

Necmi Eren

Ozkan Gungor

Fatih Dede

Tamer Dincer

Kultigin Turkmen

Taner Basturk

Murat Duranay

Hakki Arikan

Onur Tunca

Omer Celal Elcioglu

Erhan Tatar

Zeki Aydin

Deren Oygar

Serap Demir

Mehmet Tanrisev

Ilhan Kurultak

Aysegul Oruc

Aydin Turkmen

Omer Faruk Akcay

Hakki Cetinkaya

Savas Ozturk

Affiliations

Soon will be listed here.

Abstract

Background: Data on the prognostic factors for C3 glomerulopathy (C3G) are limited, and validation of the new C3G histologic index (C3G-HI) in different settings is still needed. We aimed to evaluate the chronicity score of C3G-HI and probable prognostic factors in our population.

Methods: In this registry study, 74 patients from 20 centers with adequate follow-up data were included. Total chronicity score (TCS) was calculated according to percentages of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and presence of arterio- and arteriolosclerosis. Primary composite outcome was defined as doubling of serum creatinine from baseline, undergoing dialysis or transplantation, development of stage 5 chronic kidney disease, or death.

Results: Median age was 34 [interquartile range (IQR) 24-46] years, and 39 patients (52.7%) were male. Median follow-up duration was 36 (IQR 12-60) months, and median TCS was 3 (IQR 1-5). Overall, 19 patients (25.7%) experienced primary composite outcome. Multivariate Cox regression model showed that only hemoglobin [adjusted HR (aHR) 0.67, 95% confidence interval 0.46-0.97, = .035] predicted primary composite outcome, and TCS fell short of the statistical significance (aHR 1.26, 0.97-1.64, = .08). Receiver operating characteristic analysis demonstrated that TCS showed an area under the curve value of 0.68 (0.56-0.78, = .028) in discriminating primary composite outcome at 3 years, and 3-year kidney survival was lower in patients with TCS ≥4 (72.4%) compared with TCS <4 (91.1%) in Kaplan-Meier analysis (= .036).

Conclusions: Low hemoglobin levels predicted dismal outcomes in patients with C3G. TCS ≥4 was associated with a worse 3-year kidney survival, which validated the 3-year prognostic value of the TCS of C3G-HI in our population.

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