Corticosteroid Therapy Improves Renal Prognosis in IgAN Patients with Crescent
Bibliographic record
Abstract
Background: IgA nephropathy (IgAN) has been identified as having an inflammatory basis leading to the biological rationale of immunosuppressive therapy. However, little is known about the clinical indication of immunosuppressive therapy related to each histological finding. Recently, Haas et al reported that the crescent lesion is an independent predictor for renal survival in IgAN especially with no immunosuppressive therapy. We assessed the effect of corticosteroid therapy on renal survival of IgAN with crescent based on the Japanese dataset used in the recently published IgAN prediction tool from multinational multi-ethnic cohort (Barbour SJ, JAMA Intern Med. 2019), given it was almost all corticosteroids. Methods: We extracted the 566 Japanese adults with biopsy-proven IgAN patients (male 45.9%, median age 34.7) from original cohort. Baseline characteristics were evaluated at the biopsy, and clinical data including serum creatinine, urinary findings, use of RAS blockers (RASB) and corticosteroid therapy and tonsillectomy were collected at every visit. The outcome was defined as 50% decline in eGFR or end-stage kidney disease. Cox proportional hazard models were used to investigate the association between corticosteroid therapy and renal survival with adjustments of confounders including the Oxford classification. Treatment options were included in the model as time-dependent covariates. Results: At biopsy, median eGFR and proteinuria and proportions of the patients with crescent were 73.2ml/min/1.73m2, 0.67g/day, and 59.9%, respectively. During a median follow-up of 3.79 years, 57 patients (10.1%) reached the outcome. RASB and corticosteroid were used in 377 patients (66.6%) and 368 patients (65.0%), respectively. 241 (42.6%) patients were performed tonsillectomy. Hazard ratio (HR) of corticosteroid therapy was reversed by presence of crescent (no crescent: HR 1.75 95% confidence interval [CI] 0.72-4.23, presence of crescent: HR 0.26 95%CI 0.11-0.61), indicating the interaction between corticosteroid therapy and presence of crescent (p<0.001). Tonsillectomy had also a favorable effect on renal survival (HR 0.43 95%CI 0.20-0.91). Conclusions: Present findings revealed that corticosteroid therapy improved renal survival in Japanese IgAN patients with crescent and are thus suggestive for the indication of this therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".