Histological grading in primary membranous nephropathy is essential for clinical management and predicts outcome of patients
| العنوان: | Histological grading in primary membranous nephropathy is essential for clinical management and predicts outcome of patients |
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| المؤلفون: | Ioannis Stefanidis, Nikolaos Kaperonis, Panagiota Manolakaki, Demetrios Vlahakos, Kostas Stylianou, Christos Dioudis, Hara Gakiopoulou, Aikaterini Papagianni, Christina Nikolaidou, Paraskevi-Evi Andronikidi, George Moustakas, Spyridon Golfinopoulos, Irene Grapsa, Dimitrios S. Goumenos, Vasiliki Choulitoudi, Evangelos Papachristou, Synodi Zerbala, John Boletis, Christina Vourlakou, Evangelia Dounousi, Athanasios Sioulis, Paraskevi Pavlakou, Maria Tsilivigkou, Kyriaki Kolovou, Christos Iatrou, Dimitra Galitsiou, Ioanna-Theologia Lampropoulou, George Liapis, Theofanis Apostolou, Efstathios Mitsopoulos, Christos Paliouras, Stylianos Panagoutsos, Eugene Dafnis, Aimilios Andrikos, Olga Balafa, Smaragdi Marinaki, Panagiota Papadea, Sophia Spaia, Apostolos Papadogianakis, Panagiotis Pateinakis, Maria Stangou, Ioannis Tzanakis, Eufemia Balassi |
| المصدر: | Histopathology |
| بيانات النشر: | John Wiley and Sons Inc., 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | 0301 basic medicine, focal sclerosis, Adult, Male, medicine.medical_specialty, Histology, Adolescent, medicine.medical_treatment, Biopsy, Renal function, Disease, Kidney, Gastroenterology, Glomerulonephritis, Membranous, Pathology and Forensic Medicine, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Membranous nephropathy, Internal medicine, medicine, Humans, Grading (tumors), Aged, Retrospective Studies, Aged, 80 and over, business.industry, vascular hyalinosis, Histocytochemistry, Immunosuppression, General Medicine, Original Articles, interstitial fibrosis, Middle Aged, medicine.disease, Prognosis, primary membranous nephropathy, 030104 developmental biology, 030220 oncology & carcinogenesis, outcome, Immunohistochemistry, Original Article, Female, Kidney Diseases, tubular atrophy, business, Nephrotic syndrome, Immunosuppressive Agents |
| الوصف: | Aims Diagnosis of primary membranous nephropathy (PMN) is mainly based on immunofluorescence/immunohistochemistry findings. However, assessment of specific features on optical microscopy can help to estimate the severity of the disease, guide treatment and predict the response. The aim of this study was to identify, classify and grade the precise histological findings in PMN to predict renal function outcome and guide treatment. Methods and results Histological parameters, including focal segmental sclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF) and vascular hyalinosis (VH), were re‐evaluated in 752 patients with PMN. Their predictive value was estimated separately, and also in a combination score (FSTIV) graded from 0 to 4. Finally, the impact of histology was assessed in the response to immunosuppressive treatment. Mean age of patients was 53.3 (15–85) years and most presented with nephrotic syndrome. FSGS was present in 32% and VH in 51% of the patients, while TA and IF were graded as stage ≥1 in 52% and 51.4%, respectively. The follow‐up period was 122.3 (112–376) months. FSGS, TA and IF and VH were associated with impaired renal function at diagnosis (P = 0.02, P 50% eGFR reduction, FSGS (P = 0.001) and TA (P = 0.02). Also, patients presented with FSGS, IF, VH and/or with FSTIV > 1 could benefit from immunosuppression, regardless of clinical presentation. Conclusions The presence and degree of four histological indices, FSGS, VH, TA and IF, assessed separately or in combination, and FSTIV score not only predict renal function outcome after long‐term follow‐up, but can also help in the choice of appropriate treatment. Decisions concerning immunosuppressive treatment can be guided by pathology regardless of clinical findings. |
| اللغة: | English |
| تدمد: | 1365-2559 0309-0167 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3cc70faec4769359c6e6604abaad8c16 http://europepmc.org/articles/PMC6856983 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....3cc70faec4769359c6e6604abaad8c16 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 13652559 03090167 |
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