Is it possible to predict the evolution of IgAN? Validation of the IgA nephropathy progression calculator and its relationship with MEST-C score in our population

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Validation of the IgA nephropathy progression calculator and its relationship with MEST-C score in our population" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "523" "paginaFinal" => "530" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Martín-Penagos, Adalberto Benito, María Victoria Oviedo, Covadonga López del Moral Cuesta, Javier Martín López, Javier Gómez Román, Raquel López-Mejías, Gema Fernandez-Fresnedo, Juan Carlos Ruíz San Millán, Emilio Rodrigo Calabia" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Luis" "apellidos" => "Martín-Penagos" "email" => array:1 [ 0 => "luis.martinp@scsalud.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Adalberto" "apellidos" => "Benito" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María Victoria" "apellidos" => "Oviedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Covadonga" "apellidos" => "López del Moral Cuesta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Javier" "apellidos" => "Martín López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "Gómez Román" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Raquel" "apellidos" => "López-Mejías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "Gema" "apellidos" => "Fernandez-Fresnedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Juan Carlos" "apellidos" => "Ruíz San Millán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Emilio" "apellidos" => "Rodrigo Calabia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Cantabria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Rio Carrión, Palencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación Instituto de Investigación Marqués de Valdecilla-IDIVAL, Santander, Cantabria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es posible predecir la evolución de la nefropatia IgA? Validamos la calculadora de progresión de nefropatia IgA y su relación con Oxford score en nuestra población" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1551 "Ancho" => 2212 "Tamanyo" => 194562 ] ] "descripcion" => array:1 [ "en" => "Regarding the variable T of the Oxford/MEST classification, with its 3 possible values, T1, T2 and T3, the greater T (tubulo-interstitial atrophy), the higher score, being the result statistically significant." ] ] ] "textoCompleto" => "IntroductionIgA glomerulonephritis, first described by Berger and Hinglais in 1968,<a class="elsevierStyleCrossRef" href="#bib0215">1</a> was described as a very frequent glomerular disease with a benign course<a class="elsevierStyleCrossRef" href="#bib0220">2</a>; nowadays we know that it is not this is not totally true.In IgA nephropathy, sometimes the clinical course may be indolent, and hematuria may be the only manifestation of the disease for many years and without progression over time. However a significant number of patients, up to 40% in some series, progress over the years toward a chronic kidney disease, eventually requiring renal replacement therapy after decades. Occasionally, the disease progresses more rapidly to end-stage renal disease in months or a few years.<a class="elsevierStyleCrossRefs" href="#bib0225">3,4</a>Thus, there is variability with respect to progression and prognosis of this disease, initially considered a benign entity but today we know that this is not the case, being the most frequent primary glomerular disease leading to dialysis.<a class="elsevierStyleCrossRefs" href="#bib0235">5,6</a>In recent years different prognostic tools have been developed to predict the risk of end-stage renal disease in patients diagnosed with IgA nephropathy.<a class="elsevierStyleCrossRef" href="#bib0245">7</a> Those showing the greatest relationship with progression are based on histology, such as the Oxford/MEST score<a class="elsevierStyleCrossRef" href="#bib0250">8</a> classification, completed in recent years by the association of crescents (to the score MEST, named MEST-C<a class="elsevierStyleCrossRef" href="#bib0255">9</a>). These are invasive techniques, requiring renal biopsy.Also recently, non-invasive clinical tools to predict progression of the disease have been described. One of them is the IgA nephropathy progression calculator (IgANPC),<a class="elsevierStyleCrossRef" href="#bib0260">10</a> only validated in the Chinese population, which includes 4 clinical and analytical parameters at the diagnosis of the disease. However, a validated tool to predict the progression of this entity is not yet available in the general population.In the present study we analyze the prediction capacity of the IgANPC in our population, as well as its link with the MEST-C classification, relating the different MEST-C variables with this calculator.Material and methodsDuring the last 25 years we have performed 866 kidney biopsies in patients from our center. The reference area of our hospital for renal biopsies currently includes the entire province of Cantabria and Río Carrión Palencia Hospital Complex; years ago it also included the Bierzo hospital in León, so in our study there are also some patients from these regions.This is a retrospective study using all patients with kidney biopsy from 1990 to 2015. Of these, 108 patients were diagnosed of IgA glomerulonephritis. Analytical, clinical and demographic data was collected. Patients not included in the analysis were those with incomplete follow-up (n=17), less than 18 years old (n=11) and those with incomplete data in their records (n=32 patients of the hospital El Bierzo and Río Carrión). For patients of Palencia that did have a correct follow-up, we had the collaboration of the Nephrology Service of the Rio Carrión Hospital. A total of 48 patients were analyzed.The following demographic,clinical and biochemical parameters in blood and urine were collected: age, height, weight, systolic blood pressure (SBP) and diastolic blood pressure, presence or absence of macroscopic hematuria, creatinine, CKD-EPI, serum albumin, uric acid, hemoglobin, 24h proteinuria, protein/creatinine ratio in an urine sample, hemoglobinuria and hematuria in the urinary sediment. All this information was obtained at the time of the kidney biopsy, 2 years after and at the end of the follow-up or initiation of renal replacement therapy (RRT). The time at which the glomerular filtration rate (GFR) fell below 30ml/min or the initial value of serum creatinine doubled were also collected.Regarding the histology data, the following parameters were collected: the number of glomeruli, the number of sclerosed glomeruli and the variables of the MEST, the percentage of crescents and the presence of C4d and C3 by immunofluorescence.All biopsies were reviewed and reclassified according to the Oxford/MEST-C criteria with the help of our Pathology Department.In addition, the risk of progression was calculated using the online calculator IgANPC (<a href="http://www.columbiamedicine.org/divisions/gharavi/calc_progression.php">http://www.columbiamedicine.org/divisions/gharavi/calc_progression.php</a>). This calculator is based on 4 parameters, both clinical and biochemical, obtained at the time of the kidney biopsy. The parameters on which it is based are: GFR, serum hemoglobin (g/dl), serum albumin (g/dl) and systolic blood pressure (mmHg). Depending on the values obtained, patients are classified as low risk (<−0.887), medium (between −0.887 and 0.993) or high (>0.993), and the result of this calculator was recorded.Statistic analysisContinuous variables are shown as mean±standard deviation, and qualitative variables are expressed as frequency and percentage.The Mann–Whitney U test was used for comparison of quantitative variables of the MEST-C and the IgANPC scores. The Kruskal–Wallis test was used in the case of the variable time T (T0, T1 and T2 to define the degree of fibrosis and tubulo-interstitial atrophy).The IgANPC score as a continuous variable was correlated with the percentage of crescents and the number of sclerosed glomeruli using Pearson correlation test.The log rank comparison test was applied for variables of the MEST-C score and the time elapsed to reach end stage renal disease (ESRD).Cox regression analysis was used to relate the different variables of the MEST-C score with the time elapsed to ESRD.Kaplan–Meier curves were performed to determine the influence of the score on the progression to advanced chronic renal disease (estimated GFR<30ml/min).The SPSS for Windows version 15.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis.ResultsIn our renal biopsies, IgA constitutes 12% of the diagnosis. The percent of males and female was 83% and 17%, respectively.The average age at the time of the biopsy was 45.3 years, with a standard deviation of 20.8 years. The mean serum creatinine was 2mg/dl with eGFR of 62.1±43.3ml/min (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Based on the score obtained with the IgANPC, patients were classified into 3-risk groups. In the low risk group there were 25% of patients, in the intermediate and high risk groups 27.1% and 47.9% respectively. After 10 years, all patients classified in the low-risk group (group 1) of IgANPC maintain a eGFR>30ml/min while in the medium risk group (group 2) only 68.6% had eGFR>30ml/min and none of the patients in the high risk group (group 3) have a eGFR>30ml/min at 10 years (p=0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>After reclassifying the biopsies using the MEST-C, the percent of patients in M1 was 83%, being 35% in E1, 39.6% in S1 and T0 47.9%, T1 39.6% and T2 12.5%.The relationship between the value of each MEST-C variable and the probability of progression calculated using the IgANPC was analyzed. It was observed a concordance between patients with a high IgANPC score and E1 (p=0.021). Likewise, we found a relationship between the score and T (p=0.026); the higher the score, the greater the tubulo-interstitial atrophy (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The rest of the MEST-C variables were not statistically related to the IgANPC score.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>There was a significant correlation (Pearson's correlation) between the percentage of crescents and the IgANPC (r=0.375, p=0.014). No significant correlations were found between the other variables (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>By log rank test the period of time elapsed until reaching ESRD was significantly related to MEST-C score variables E (p<0.036) and S (p<0.022).Cox regression analysis shows that ESRD is significantly related with IgANPC (p=0.028) (HR=1.864 (95% CI, 1.127–3.083). ESRD is also related with T1 (HR=4.465; 95% CI, 1.179–16.905). Multivariate analysis shows a strong correlation between IgANPC with eGFR<30ml/min and the risk group (p=0.016) (HR=13.701; CI 95%, 1.644–114.209).Patients with the highest histological variables of E and T (the MEST groups of E1 and T2 and T3) showed a higher risk of reaching eGFR<30ml/min (p=0.016 and p=0.001, respectively).The multivariate analysis showed that the IgANPC score is independently related with a higher risk of developing a eGFR<30ml/min (HR=13.701; 95% CI, 644–114.209; p=0.016).The ROC curve predicting eGFR<30ml/mim by IgANPC score shows an area under the curve of 0.843 which indicates that the test is a good predictor (between 0.75 and 0.90) of progression to advanced renal disease (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Discussion and conclusionsThe IgA glomerulonephritis is underdiagnosed and its evolution is heterogeneous. Factors strongly related to the progression to ESRD are the presence of persistent proteinuria 1.000mg/24h, hypertension (BP>140/90mmHg) and elevated serum creatinine<a class="elsevierStyleCrossRefs" href="#bib0265">11–14</a>; the patients who combine the high creatinine and proteinuria have the greatest risk of progression, presenting ESRD in 15–25% after 10 years, and 20–30% after 20 years of follow-up.<a class="elsevierStyleCrossRefs" href="#bib0285">15–18</a> The persistence of hematuria has been also associated with a poor prognosis in different studies.<a class="elsevierStyleCrossRefs" href="#bib0305">19–23</a>There is evidence that many patients with IgA glomerulonephritis have a deficit in the glycosylation of the IgA1 molecule and this abnormality may be an important factor in the genesis of this disease.<a class="elsevierStyleCrossRefs" href="#bib0330">24–31</a>Yanagawa et al. demonstrated that galactosyl-deficient anti-IgA IgG present an area under the ROC curve of 0.813 to discriminate IgA nephropathy from other autoimmune causes of chronic renal diseases.<a class="elsevierStyleCrossRef" href="#bib0370">32</a> Recently, galactosyl-deficient IgA has also been related to renal prognosis in patients with IgA nephropathy.<a class="elsevierStyleCrossRefs" href="#bib0375">33–35</a>Different groups have used these serological markers to assess disease activity and their response to different treatments. Berthelot et al. demonstrated that levels of IgA1 galacto sil-deficient, anti-IgA galactosyl-deficient IgG and the soluble CD89-IgA complex predicts recurrence after renal transplantation.<a class="elsevierStyleCrossRef" href="#bib0390">36</a> Other groups have observed that steroid treatment reduces levels of galactosyl-deficient IgA1, while the use of rituximab does not decrease levels of galactosyl-deficient IgA1 and galactosyl-deficient IgA IgG, which could explain its lack of efficacy. to treat IgA nephropathy.<a class="elsevierStyleCrossRefs" href="#bib0395">37,38</a> The possibility of having a future treatment of IgA nephropathy, as observed in some animal models, using of recombinant IgA1 protease makes these serological markers available of maximum interest<a class="elsevierStyleCrossRef" href="#bib0405">39</a> to monitor this nephropathy.Given the frequency of IgA nephropathy, it is necessary to have tools that allow us to know in the best no invasive way, the probability of progression to ESRD to help the clinician to select patients susceptible to treatment and also give the most accurate information about the prognosis at the time of diagnosis. The prognostic tools available today are clearly insufficient and all input is welcome.In the present study, we have not directly analyzed the classic parameters that have been related to progression, although creatinine and hypertension are included in the IgANPC, since the calculation is made based on eGFR, Systolic blood pressure, albumin and serum hemoglobin.Regarding proteinuria, persistent hematuria and other markers that have been classically associated with prognosis and MEST,<a class="elsevierStyleCrossRefs" href="#bib0410">40–42</a> it has not been the subject of analysis in this work.In 2014, a work by the VALIGA group of the ERA-EDTA by Coppo et al. in Kidney International, different variables of the MEST are related with the prognosis of IgA nephropathy. In this work, a greater value of the variables M, S and T is related to a worse prognosis, and this association is independent of other variables. When the histological changes of the MEST are related to clinical variables such as proteinuria, the prognostic capacity of the test increases significantly in the group of untreated patients.<a class="elsevierStyleCrossRef" href="#bib0415">41</a>We have demonstrated in our group of patients that the IgANPC is an adequate tool to predict the period of time to reach FGe<30ml/min, and adds prognostic information independent of the MEST-C. In addition, this is a non-invasive tool that, unlike MEST-C, does not require a renal biopsy for its calculation. It also allows us to give concrete prognostic figures regarding the risk of developing ERCT or the need for renal replacement therapy, by expressing its result in a percentage. The latter allows the clinician to inform the patient about the prognosis in a clear and understandable way based not only in professional experience but also on a standardized tool.In recent years, the MEST classification has been optimized by adding the percentage of crescents to this score.<a class="elsevierStyleCrossRef" href="#bib0255">9</a> Our study confirms that this is correct, we found that the group with high-risk of progression of the disease had a higher percentage of lesions with extracapillary proliferation.We can conclude that the classification of MEST-C score and the IgANPC score are useful and independent tools for prognostic prediction, it is necessary to validate their use in the general population and relate them to the available serological markers.Limitations of the studyFirst, this study is a retrospective analysis, with the biases inherent to this type of analysis. Nevertheless, it is the first study to evaluate and match IgANPC and MEST-C score in our population. Second, the number of patients analyzed is low, so the power of statistical results obtained is limited. Third, our data refers to the population of Cantabria and Palencia in Spain, therefore, they cannot be completely extrapolated to other geographical areas. Fourth, the clinical follow-up of the patients was very uneven in time (with a dispersion of 2 years the least follow-up, and 22 years the longest), which may be related to the absence of differences in the variables of clinical assessment between the study groups.Conflict of interestsThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1276539" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1180640" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1276540" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1180641" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistic analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0025" "titulo" => "Discussion and conclusions" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Limitations of the study" ] ] ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-12" "fechaAceptado" => "2018-10-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1180640" "palabras" => array:4 [ 0 => "IgA nephropathy" 1 => "Prognostic prediction tools" 2 => "Oxford score (MEST-C)" 3 => "IGA Nephropathy Prognostic Calculator" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1180641" "palabras" => array:4 [ 0 => "Nefropatía IgA" 1 => "Herramientas de predicción pronóstica" 2 => "Oxford score (MEST-C)" 3 => "IGA Nephropathy Prognostic Calculator" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionIgA nephropathy (IgAN) is the most common and heterogeneous glomerular nephropathy. Several strategies have been used to determine the risk of progression to ESRD. We evaluate the prognostic significance and correlate the IgAN progression calculator (IgANPC) and the Oxford/MEST-C score in our population. Material and methodsWe performed a retrospective study of biopsied patients with diagnosis of IgA nephropathy from 1990 to 2015. We classified the biopsies using MEST-C score and we correlated the score to clinical evolution. We also calculated the risk of progression with the online IgANPC at the time of the biopsy. ResultsWe analyzed 48 biopsies, 83% of which were men with a mean age of 45 years at the time of the biopsy.Patients with a biopsy E1 according to MEST-C score had a higher IgANPC score than those with E0 (p=.021).The Pearson's correlation for the percentage of crescents and the IgANPC risk score was statistically significant (p=.014) with r=0.357.The percentage of patients with eGFR above 30ml/min at 10 years was 100% for the low-risk group (group 1 of IgANPC), and 0% for the high-risk group (group 3), log rank p=0.001.The log rank comparison for variables of the MEST-C score, presented statistically significant results between E (0.036) and S (0.022) and the eGFR time<30ml/min.A statistically significant relationship was also observed between T1 and eGFR<30ml/min.The multivariate Cox regression analysis for IgANPC and eGFR<30ml/min demonstrated a strong correlation (p=.016) between the risk group and eGFR<30ml/min. ConclusionIn our study population, the IgANPC predicts the time to eGFR<30ml/min, and adds information independent of the MEST.The MEST-C classification and IgANPC are useful and independent ÿolos for prognostic prediction, but more studies are needed to validate its use in the general population." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa nefropatía IgA es la enfermedad glomerular más frecuente y heterogénea.Hay estrategias histológicas y clínicas para determinar la progresión a ESRD.Valoramos el significado pronóstico de la clasificación de Oxford/MEST-C y la calculadora de progresión de la NIgA (IgANPC) en nuestra población y relacionamos ambas herramientas. Material y métodosRealizamos un estudio retrospectivo de biopsias NIgA de 1990 hasta 2015. Se realizó el MEST de las biopsias y se calculó el riesgo de progresión con IgANPC. Se relaciona con la evolución clínica. ResultadosSe analizaron 48 biopsias, 83% varones de 45 años de media.La correlación entre el MEST-C y el IgANPC score a la biopsia mostró una concordancia entre pacientes con un score IgANPC alto y E1 (p = 0,021).La correlación de Pearson para el porcentaje de semilunas y el IgAPC es estadísticamente significativo (p = 0,014) con r: 0,357.El 100% de los pacientes clasificados en el grupo 1 de IgANPC mantienen un FGe> 30ml/min a 10 años, mientras que ninguno de los del grupo 3 presenta un FGe> 30ml/min a 10 años (p = 0,001).La comparación de log rank para variables del MEST-C score presenta resultados estadísticamente significativos entre E (0,036) y S (0,022), y el tiempo a FGe <30ml/min.También se observa una relación estadísticamente significativa entre T1 y FGe <30ml/min.El análisis multivariante con la regresión de Cox para IgANPC y FGe<30ml/min muestra una fuerte correlación (p = 0,016) entre el grupo de riesgo y FGe <30ml/min. ConclusiónIgANP predice el tiempo hasta FGe <30ml/min y añade información independiente del MEST.La clasificación de MEST-C score y el IgANPC score son útiles e independientes para la predicción pronóstica; queda validar su uso en la población general." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Martín-Penagos L, Benito A, Oviedo MV, López del Moral Cuesta C, Martín López J, Gómez Román J, et al. ¿Es posible predecir la evolución de la nefropatia IgA? Validamos la calculadora de progresión de nefropatia IgA y su relación con Oxford score en nuestra población. Nefrología. 2019;39:523–530." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1096 "Ancho" => 2169 "Tamanyo" => 119277 ] ] "descripcion" => array:1 [ "en" => "Group 3, with a highest score, has a 100% chance of reaching FGe<30ml/min. The higher the score group, the greater the probability of advanced chronic renal failure." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1476 "Ancho" => 2167 "Tamanyo" => 156467 ] ] "descripcion" => array:1 [ "en" => "The variable E1 of the Oxford/MEST classification is directly related with the score obtained with the IgANPC calculator and the association is statistically significant." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1551 "Ancho" => 2212 "Tamanyo" => 194562 ] ] "descripcion" => array:1 [ "en" => "Regarding the variable T of the Oxford/MEST classification, with its 3 possible values, T1, T2 and T3, the greater T (tubulo-interstitial atrophy), the higher score, being the result statistically significant." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1796 "Ancho" => 2527 "Tamanyo" => 243701 ] ] "descripcion" => array:1 [ "en" => "Pearson's correlation for glomerular sclerosis and percentage of crescents with IgANPC (calculated score)." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1406 "Ancho" => 2177 "Tamanyo" => 155066 ] ] "descripcion" => array:1 [ "en" => "ROC curve to analyze the ability of the test to predict an eGFR of less than 30ml/min based on the IgANPC score. AUC=0.843." ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Minimum \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Maximum \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">25th percentile \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">50th percentile \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">75th percentile \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glomeruli number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sclerosed glomeruli number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">% crescents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine Bx. (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">eGFRF Bx. (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">165 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2183495.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the patients characteristics." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0215" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Les depots intercapillaires d’IgA-IgG" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Berger" 1 => "N. Hinglais" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Urol Nephrol" "fecha" => "1968" "volumen" => "74" "paginaInicial" => "694" "paginaFinal" => "695" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0220" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent haematuria in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Bodian" 1 => "J.A. Black" 2 => "N. Kobayashi" 3 => "B.D. Lake" 4 => "S.E. 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¿Es posible predecir la evolución de la nefropatia IgA? Validamos la calculadora de progresión de nefropatia IgA y su relación con Oxford score en nuestra población

Luis Martín-Penagosa,

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luis.martinp@scsalud.es

Corresponding author.

, Adalberto Benitoa, María Victoria Oviedob, Covadonga López del Moral Cuestaa, Javier Martín Lópezc, Javier Gómez Románc, Raquel López-Mejíasd, Gema Fernandez-Fresnedoa, Juan Carlos Ruíz San Millána, Emilio Rodrigo Calabiaa

a Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Cantabria, Spain

b Servicio de Nefrología, Hospital Rio Carrión, Palencia, Spain

c Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

d Fundación Instituto de Investigación Marqués de Valdecilla-IDIVAL, Santander, Cantabria, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">IgA glomerulonephritis&#44; first described by Berger and Hinglais in 1968&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a> was described as a very frequent glomerular disease with a benign course<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">2</span></a>&#59; nowadays we know that it is not this is not totally true&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In IgA nephropathy&#44; sometimes the clinical course may be indolent&#44; and hematuria may be the only manifestation of the disease for many years and without progression over time&#46; However a significant number of patients&#44; up to 40&#37; in some series&#44; progress over the years toward a chronic kidney disease&#44; eventually requiring renal replacement therapy after decades&#46; Occasionally&#44; the disease progresses more rapidly to end-stage renal disease in months or a few years&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus&#44; there is variability with respect to progression and prognosis of this disease&#44; initially considered a benign entity but today we know that this is not the case&#44; being the most frequent primary glomerular disease leading to dialysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years different prognostic tools have been developed to predict the risk of end-stage renal disease in patients diagnosed with IgA nephropathy&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a> Those showing the greatest relationship with progression are based on histology&#44; such as the Oxford&#47;MEST score<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a> classification&#44; completed in recent years by the association of crescents &#40;to the score MEST&#44; named MEST-C<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#41;&#46; These are invasive techniques&#44; requiring renal biopsy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Also recently&#44; non-invasive clinical tools to predict progression of the disease have been described&#46; One of them is the IgA nephropathy progression calculator &#40;IgANPC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a> only validated in the Chinese population&#44; which includes 4 clinical and analytical parameters at the diagnosis of the disease&#46; However&#44; a validated tool to predict the progression of this entity is not yet available in the general population&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the present study we analyze the prediction capacity of the IgANPC in our population&#44; as well as its link with the MEST-C classification&#44; relating the different MEST-C variables with this calculator&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">During the last 25 years we have performed 866 kidney biopsies in patients from our center&#46; The reference area of our hospital for renal biopsies currently includes the entire province of Cantabria and R&#237;o Carri&#243;n Palencia Hospital Complex&#59; years ago it also included the Bierzo hospital in Le&#243;n&#44; so in our study there are also some patients from these regions&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This is a retrospective study using all patients with kidney biopsy from 1990 to 2015&#46; Of these&#44; 108 patients were diagnosed of IgA glomerulonephritis&#46; Analytical&#44; clinical and demographic data was collected&#46; Patients not included in the analysis were those with incomplete follow-up &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; less than 18 years old &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41; and those with incomplete data in their records &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 patients of the hospital El Bierzo and R&#237;o Carri&#243;n&#41;&#46; For patients of Palencia that did have a correct follow-up&#44; we had the collaboration of the Nephrology Service of the Rio Carri&#243;n Hospital&#46; A total of 48 patients were analyzed&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following demographic&#44;clinical and biochemical parameters in blood and urine were collected&#58; age&#44; height&#44; weight&#44; systolic blood pressure &#40;SBP&#41; and diastolic blood pressure&#44; presence or absence of macroscopic hematuria&#44; creatinine&#44; CKD-EPI&#44; serum albumin&#44; uric acid&#44; hemoglobin&#44; 24<span class="elsevierStyleHsp" style=""></span>h proteinuria&#44; protein&#47;creatinine ratio in an urine sample&#44; hemoglobinuria and hematuria in the urinary sediment&#46; All this information was obtained at the time of the kidney biopsy&#44; 2 years after and at the end of the follow-up or initiation of renal replacement therapy &#40;RRT&#41;&#46; The time at which the glomerular filtration rate &#40;GFR&#41; fell below 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min or the initial value of serum creatinine doubled were also collected&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the histology data&#44; the following parameters were collected&#58; the number of glomeruli&#44; the number of sclerosed glomeruli and the variables of the MEST&#44; the percentage of crescents and the presence of C4d and C3 by immunofluorescence&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All biopsies were reviewed and reclassified according to the Oxford&#47;MEST-C criteria with the help of our Pathology Department&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition&#44; the risk of progression was calculated using the online calculator IgANPC &#40;<a href="http://www.columbiamedicine.org/divisions/gharavi/calc_progression.php">http&#58;&#47;&#47;www&#46;columbiamedicine&#46;org&#47;divisions&#47;gharavi&#47;calc&#95;progression&#46;php</a>&#41;&#46; This calculator is based on 4 parameters&#44; both clinical and biochemical&#44; obtained at the time of the kidney biopsy&#46; The parameters on which it is based are&#58; GFR&#44; serum hemoglobin &#40;g&#47;dl&#41;&#44; serum albumin &#40;g&#47;dl&#41; and systolic blood pressure &#40;mmHg&#41;&#46; Depending on the values obtained&#44; patients are classified as low risk &#40;&#60;&#8722;0&#46;887&#41;&#44; medium &#40;between &#8722;0&#46;887 and 0&#46;993&#41; or high &#40;&#62;0&#46;993&#41;&#44; and the result of this calculator was recorded&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistic analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Continuous variables are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; and qualitative variables are expressed as frequency and percentage&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for comparison of quantitative variables of the MEST-C and the IgANPC scores&#46; The Kruskal&#8211;Wallis test was used in the case of the variable time T &#40;T0&#44; T1 and T2 to define the degree of fibrosis and tubulo-interstitial atrophy&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The IgANPC score as a continuous variable was correlated with the percentage of crescents and the number of sclerosed glomeruli using Pearson correlation test&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The log rank comparison test was applied for variables of the MEST-C score and the time elapsed to reach end stage renal disease &#40;ESRD&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cox regression analysis was used to relate the different variables of the MEST-C score with the time elapsed to ESRD&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Kaplan&#8211;Meier curves were performed to determine the influence of the score on the progression to advanced chronic renal disease &#40;estimated GFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The SPSS for Windows version 15&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; was used for statistical analysis&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">In our renal biopsies&#44; IgA constitutes 12&#37; of the diagnosis&#46; The percent of males and female was 83&#37; and 17&#37;&#44; respectively&#46;The average age at the time of the biopsy was 45&#46;3 years&#44; with a standard deviation of 20&#46;8 years&#46; The mean serum creatinine was 2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl with eGFR of 62&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43&#46;3<span class="elsevierStyleHsp" style=""></span>ml&#47;min &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Based on the score obtained with the IgANPC&#44; patients were classified into 3-risk groups&#46; In the low risk group there were 25&#37; of patients&#44; in the intermediate and high risk groups 27&#46;1&#37; and 47&#46;9&#37; respectively&#46; After 10 years&#44; all patients classified in the low-risk group &#40;group 1&#41; of IgANPC maintain a eGFR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min while in the medium risk group &#40;group 2&#41; only 68&#46;6&#37; had eGFR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min and none of the patients in the high risk group &#40;group 3&#41; have a eGFR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min at 10 years &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">After reclassifying the biopsies using the MEST-C&#44; the percent of patients in M1 was 83&#37;&#44; being 35&#37; in E1&#44; 39&#46;6&#37; in S1 and T0 47&#46;9&#37;&#44; T1 39&#46;6&#37; and T2 12&#46;5&#37;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The relationship between the value of each MEST-C variable and the probability of progression calculated using the IgANPC was analyzed&#46; It was observed a concordance between patients with a high IgANPC score and E1 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41;&#46; Likewise&#44; we found a relationship between the score and T &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#59; the higher the score&#44; the greater the tubulo-interstitial atrophy &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The rest of the MEST-C variables were not statistically related to the IgANPC score&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">There was a significant correlation &#40;Pearson&#39;s correlation&#41; between the percentage of crescents and the IgANPC &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;375&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#46; No significant correlations were found between the other variables &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">By log rank test the period of time elapsed until reaching ESRD was significantly related to MEST-C score variables E &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;036&#41; and S &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Cox regression analysis shows that ESRD is significantly related with IgANPC &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41; &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;864 &#40;95&#37; CI&#44; 1&#46;127&#8211;3&#46;083&#41;&#46; ESRD is also related with T1 &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;465&#59; 95&#37; CI&#44; 1&#46;179&#8211;16&#46;905&#41;&#46; Multivariate analysis shows a strong correlation between IgANPC with eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min and the risk group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41; &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;701&#59; CI 95&#37;&#44; 1&#46;644&#8211;114&#46;209&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Patients with the highest histological variables of E and T &#40;the MEST groups of E1 and T2 and T3&#41; showed a higher risk of reaching eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The multivariate analysis showed that the IgANPC score is independently related with a higher risk of developing a eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;701&#59; 95&#37; CI&#44; 644&#8211;114&#46;209&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The ROC curve predicting eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;mim by IgANPC score shows an area under the curve of 0&#46;843 which indicates that the test is a good predictor &#40;between 0&#46;75 and 0&#46;90&#41; of progression to advanced renal disease &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion and conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">The IgA glomerulonephritis is underdiagnosed and its evolution is heterogeneous&#46; Factors strongly related to the progression to ESRD are the presence of persistent proteinuria 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#44; hypertension &#40;BP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and elevated serum creatinine<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">11&#8211;14</span></a>&#59; the patients who combine the high creatinine and proteinuria have the greatest risk of progression&#44; presenting ESRD in 15&#8211;25&#37; after 10 years&#44; and 20&#8211;30&#37; after 20 years of follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">15&#8211;18</span></a> The persistence of hematuria has been also associated with a poor prognosis in different studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">19&#8211;23</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">There is evidence that many patients with IgA glomerulonephritis have a deficit in the glycosylation of the IgA1 molecule and this abnormality may be an important factor in the genesis of this disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">24&#8211;31</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Yanagawa et al&#46; demonstrated that galactosyl-deficient anti-IgA IgG present an area under the ROC curve of 0&#46;813 to discriminate IgA nephropathy from other autoimmune causes of chronic renal diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">32</span></a> Recently&#44; galactosyl-deficient IgA has also been related to renal prognosis in patients with IgA nephropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">33&#8211;35</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Different groups have used these serological markers to assess disease activity and their response to different treatments&#46; Berthelot et al&#46; demonstrated that levels of IgA1 galacto sil-deficient&#44; anti-IgA galactosyl-deficient IgG and the soluble CD89-IgA complex predicts recurrence after renal transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">36</span></a> Other groups have observed that steroid treatment reduces levels of galactosyl-deficient IgA1&#44; while the use of rituximab does not decrease levels of galactosyl-deficient IgA1 and galactosyl-deficient IgA IgG&#44; which could explain its lack of efficacy&#46; to treat IgA nephropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">37&#44;38</span></a> The possibility of having a future treatment of IgA nephropathy&#44; as observed in some animal models&#44; using of recombinant IgA1 protease makes these serological markers available of maximum interest<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">39</span></a> to monitor this nephropathy&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Given the frequency of IgA nephropathy&#44; it is necessary to have tools that allow us to know in the best no invasive way&#44; the probability of progression to ESRD to help the clinician to select patients susceptible to treatment and also give the most accurate information about the prognosis at the time of diagnosis&#46; The prognostic tools available today are clearly insufficient and all input is welcome&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In the present study&#44; we have not directly analyzed the classic parameters that have been related to progression&#44; although creatinine and hypertension are included in the IgANPC&#44; since the calculation is made based on eGFR&#44; Systolic blood pressure&#44; albumin and serum hemoglobin&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Regarding proteinuria&#44; persistent hematuria and other markers that have been classically associated with prognosis and MEST&#44;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">40&#8211;42</span></a> it has not been the subject of analysis in this work&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In 2014&#44; a work by the VALIGA group of the ERA-EDTA by Coppo et al&#46; in <span class="elsevierStyleItalic">Kidney International&#44;</span> different variables of the MEST are related with the prognosis of IgA nephropathy&#46; In this work&#44; a greater value of the variables M&#44; S and T is related to a worse prognosis&#44; and this association is independent of other variables&#46; When the histological changes of the MEST are related to clinical variables such as proteinuria&#44; the prognostic capacity of the test increases significantly in the group of untreated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">41</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">We have demonstrated in our group of patients that the IgANPC is an adequate tool to predict the period of time to reach FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#44; and adds prognostic information independent of the MEST-C&#46; In addition&#44; this is a non-invasive tool that&#44; unlike MEST-C&#44; does not require a renal biopsy for its calculation&#46; It also allows us to give concrete prognostic figures regarding the risk of developing ERCT or the need for renal replacement therapy&#44; by expressing its result in a percentage&#46; The latter allows the clinician to inform the patient about the prognosis in a clear and understandable way based not only in professional experience but also on a standardized tool&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In recent years&#44; the MEST classification has been optimized by adding the percentage of crescents to this score&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a> Our study confirms that this is correct&#44; we found that the group with high-risk of progression of the disease had a higher percentage of lesions with extracapillary proliferation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">We can conclude that the classification of MEST-C score and the IgANPC score are useful and independent tools for prognostic prediction&#44; it is necessary to validate their use in the general population and relate them to the available serological markers&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations of the study</span><p id="par0205" class="elsevierStylePara elsevierViewall">First&#44; this study is a retrospective analysis&#44; with the biases inherent to this type of analysis&#46; Nevertheless&#44; it is the first study to evaluate and match IgANPC and MEST-C score in our population&#46; Second&#44; the number of patients analyzed is low&#44; so the power of statistical results obtained is limited&#46; Third&#44; our data refers to the population of Cantabria and Palencia in Spain&#44; therefore&#44; they cannot be completely extrapolated to other geographical areas&#46; Fourth&#44; the clinical follow-up of the patients was very uneven in time &#40;with a dispersion of 2 years the least follow-up&#44; and 22 years the longest&#41;&#44; which may be related to the absence of differences in the variables of clinical assessment between the study groups&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "tienePdf" => true
    "fechaRecibido" => "2018-05-12"
    "fechaAceptado" => "2018-10-31"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:4 [
            0 => "IgA nephropathy"
            1 => "Prognostic prediction tools"
            2 => "Oxford score &#40;MEST-C&#41;"
            3 => "IGA Nephropathy Prognostic Calculator"
          ]
        ]
      ]
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          "identificador" => "xpalclavsec1180641"
          "palabras" => array:4 [
            0 => "Nefropat&#237;a IgA"
            1 => "Herramientas de predicci&#243;n pron&#243;stica"
            2 => "Oxford score &#40;MEST-C&#41;"
            3 => "IGA Nephropathy Prognostic Calculator"
          ]
        ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">IgA nephropathy &#40;IgAN&#41; is the most common and heterogeneous glomerular nephropathy&#46; Several strategies have been used to determine the risk of progression to ESRD&#46; We evaluate the prognostic significance and correlate the IgAN progression calculator &#40;IgANPC&#41; and the Oxford&#47;MEST-C score in our population&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of biopsied patients with diagnosis of IgA nephropathy from 1990 to 2015&#46; We classified the biopsies using MEST-C score and we correlated the score to clinical evolution&#46; We also calculated the risk of progression with the online IgANPC at the time of the biopsy&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed 48 biopsies&#44; 83&#37; of which were men with a mean age of 45 years at the time of the biopsy&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with a biopsy E1 according to MEST-C score had a higher IgANPC score than those with E0 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Pearson&#39;s correlation for the percentage of crescents and the IgANPC risk score was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41; with <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;357&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The percentage of patients with eGFR above 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min at 10 years was 100&#37; for the low-risk group &#40;group 1 of IgANPC&#41;&#44; and 0&#37; for the high-risk group &#40;group 3&#41;&#44; log rank <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The log rank comparison for variables of the MEST-C score&#44; presented statistically significant results between E &#40;0&#46;036&#41; and S &#40;0&#46;022&#41; and the eGFR time<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A statistically significant relationship was also observed between T1 and eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The multivariate Cox regression analysis for IgANPC and eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min demonstrated a strong correlation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41; between the risk group and eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In our study population&#44; the IgANPC predicts the time to eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#44; and adds information independent of the MEST&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The MEST-C classification and IgANPC are useful and independent &#255;olos for prognostic prediction&#44; but more studies are needed to validate its use in the general population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La nefropat&#237;a IgA es la enfermedad glomerular m&#225;s frecuente y heterog&#233;nea&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hay estrategias histol&#243;gicas y cl&#237;nicas para determinar la progresi&#243;n a ESRD&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valoramos el significado pron&#243;stico de la clasificaci&#243;n de Oxford&#47;MEST-C y la calculadora de progresi&#243;n de la NIgA &#40;IgANPC&#41; en nuestra poblaci&#243;n y relacionamos ambas herramientas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio retrospectivo de biopsias NIgA de 1990 hasta 2015&#46; Se realiz&#243; el MEST de las biopsias y se calcul&#243; el riesgo de progresi&#243;n con IgANPC&#46; Se relaciona con la evoluci&#243;n cl&#237;nica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 48 biopsias&#44; 83&#37; varones de 45 a&#241;os de media&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La correlaci&#243;n entre el MEST-C y el IgANPC score a la biopsia mostr&#243; una concordancia entre pacientes con un score IgANPC alto y E1 &#40;p &#61; 0&#44;021&#41;&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La correlaci&#243;n de Pearson para el porcentaje de semilunas y el IgAPC es estad&#237;sticamente significativo &#40;p &#61; 0&#44;014&#41; con r&#58; 0&#44;357&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">El 100&#37; de los pacientes clasificados en el grupo 1 de IgANPC mantienen un FGe<span class="elsevierStyleHsp" style=""></span>&#62; 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min a 10 a&#241;os&#44; mientras que ninguno de los del grupo 3 presenta un FGe<span class="elsevierStyleHsp" style=""></span>&#62; 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min a 10 a&#241;os &#40;p &#61; 0&#44;001&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La comparaci&#243;n de log rank para variables del MEST-C score presenta resultados estad&#237;sticamente significativos entre E &#40;0&#44;036&#41; y S &#40;0&#44;022&#41;&#44; y el tiempo a FGe &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Tambi&#233;n se observa una relaci&#243;n estad&#237;sticamente significativa entre T1 y FGe &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis multivariante con la regresi&#243;n de Cox para IgANPC y FGe&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min muestra una fuerte correlaci&#243;n &#40;p &#61; 0&#44;016&#41; entre el grupo de riesgo y FGe &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">IgANP predice el tiempo hasta FGe &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min y a&#241;ade informaci&#243;n independiente del MEST&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">La clasificaci&#243;n de MEST-C score y el IgANPC score son &#250;tiles e independientes para la predicci&#243;n pron&#243;stica&#59; queda validar su uso en la poblaci&#243;n general&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Resultados"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;n-Penagos L&#44; Benito A&#44; Oviedo MV&#44; L&#243;pez del Moral Cuesta C&#44; Mart&#237;n L&#243;pez J&#44; G&#243;mez Rom&#225;n J&#44; et al&#46; &#191;Es posible predecir la evoluci&#243;n de la nefropatia IgA&#63; Validamos la calculadora de progresi&#243;n de nefropatia IgA y su relaci&#243;n con Oxford score en nuestra poblaci&#243;n&#46; Nefrolog&#237;a&#46; 2019&#59;39&#58;523&#8211;530&#46;</p>"
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          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Group 3&#44; with a highest score&#44; has a 100&#37; chance of reaching FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; The higher the score group&#44; the greater the probability of advanced chronic renal failure&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">The variable E1 of the Oxford&#47;MEST classification is directly related with the score obtained with the IgANPC calculator and the association is statistically significant&#46;</p>"
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Regarding the variable T of the Oxford&#47;MEST classification&#44; with its 3 possible values&#44; T1&#44; T2 and T3&#44; the greater T &#40;tubulo-interstitial atrophy&#41;&#44; the higher score&#44; being the result statistically significant&#46;</p>"
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        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr4.jpeg"
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          "en" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Pearson&#39;s correlation for glomerular sclerosis and percentage of crescents with IgANPC &#40;calculated score&#41;&#46;</p>"
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      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">ROC curve to analyze the ability of the test to predict an eGFR of less than 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min based on the IgANPC score&#46; AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;843&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Minimum&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Maximum&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">25th percentile&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">50th percentile&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">75th percentile&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sclerosed glomeruli number&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#37; crescents&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Creatinine Bx&#46; &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Serum albumin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">eGFRF Bx&#46; &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2183495.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Description of the patients characteristics&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:42 [
            0 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Les depots intercapillaires d&#8217;IgA-IgG"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Berger"
                            1 => "N&#46; Hinglais"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Urol Nephrol"
                        "fecha" => "1968"
                        "volumen" => "74"
                        "paginaInicial" => "694"
                        "paginaFinal" => "695"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrent haematuria in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2019.09.002

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Year/Month	Html	Pdf	Total

2024 October	45	51	96
2024 September	63	47	110
2024 August	72	79	151
2024 July	44	46	90
2024 June	68	63	131
2024 May	63	66	129
2024 April	56	61	117
2024 March	48	32	80
2024 February	40	66	106
2024 January	37	25	62
2023 December	45	30	75
2023 November	52	46	98
2023 October	65	29	94
2023 September	36	36	72
2023 August	50	28	78
2023 July	60	35	95
2023 June	64	33	97
2023 May	74	34	108
2023 April	37	21	58
2023 March	71	25	96
2023 February	49	19	68
2023 January	33	32	65
2022 December	69	38	107
2022 November	51	35	86
2022 October	78	42	120
2022 September	60	46	106
2022 August	49	49	98
2022 July	45	44	89
2022 June	54	46	100
2022 May	81	24	105
2022 April	116	51	167
2022 March	68	51	119
2022 February	67	51	118
2022 January	71	37	108
2021 December	77	50	127
2021 November	76	34	110
2021 October	75	58	133
2021 September	70	33	103
2021 August	80	49	129
2021 July	47	32	79
2021 June	56	36	92
2021 May	41	45	86
2021 April	112	90	202
2021 March	61	28	89
2021 February	63	36	99
2021 January	62	16	78
2020 December	53	16	69
2020 November	41	14	55
2020 October	31	18	49
2020 September	46	16	62
2020 August	26	17	43
2020 July	36	12	48
2020 June	29	23	52
2020 May	52	19	71
2020 April	59	20	79
2020 March	70	20	90
2020 February	78	27	105
2020 January	100	39	139
2019 December	44	17	61
2019 November	36	25	61
2019 October	28	16	44

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