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Prognostic factors and validation of the histologic chronicity score for C3 glomerulopathy: a registry analysis
Safak Mirioglu1, Egemen Cebeci2, Halil Yazici3
1Division of Nephrology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
Insights
Low hemoglobin levels predict poor outcomes in C3 glomerulopathy (C3G) patients. A high total chronicity score (TCS) indicates worse 3-year kidney survival, validating the C3G histologic index (C3G-HI) in this population.
Area of Science:
- Nephrology
- Pathology
- Clinical Medicine
Background:
- Limited data exists on prognostic factors for C3 glomerulopathy (C3G).
- Validation of the C3G histologic index (C3G-HI) in diverse clinical settings is needed.
- This study evaluates the chronicity score component of the C3G-HI and potential prognostic factors in a specific patient cohort.
Purpose of the Study:
- To assess the prognostic value of the total chronicity score (TCS) from the C3G-HI.
- To identify probable prognostic factors for C3G progression.
- To validate the C3G-HI in a distinct patient population.
Main Methods:
- A registry study included 74 patients from 20 centers with complete follow-up data.
- Total chronicity score (TCS) was calculated based on glomerulosclerosis, interstitial fibrosis, tubular atrophy, and vascular sclerosis.
- Primary composite outcome included doubling of serum creatinine, dialysis, kidney transplantation, stage 5 CKD, or death.
Main Results:
- Hemoglobin levels were the only significant predictor of the primary composite outcome (aHR 0.67, P=.035).
- TCS did not reach statistical significance in predicting the composite outcome (aHR 1.26, P=.08) but showed discriminative ability at 3 years (AUC 0.68, P=.028).
- Patients with TCS ≥4 had significantly lower 3-year kidney survival (72.4%) compared to those with TCS <4 (91.1%, P=.036).
Conclusions:
- Low hemoglobin levels are associated with adverse outcomes in C3G patients.
- A TCS of 4 or higher predicts worse 3-year kidney survival.
- The study validates the prognostic utility of the TCS component of the C3G-HI for 3-year kidney survival in this cohort.
Background:
Data on the prognostic factors for C3 glomerulopathy (C3G) are limited, and validation of the new C3G histologic index (C3G-HI) in different settings is still needed. We aimed to evaluate the chronicity score of C3G-HI and probable prognostic factors in our population.
Methods:
In this registry study, 74 patients from 20 centers with adequate follow-up data were included. Total chronicity score (TCS) was calculated according to percentages of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and presence of arterio- and arteriolosclerosis. Primary composite outcome was defined as doubling of serum creatinine from baseline, undergoing dialysis or transplantation, development of stage 5 chronic kidney disease, or death.
Results:
Median age was 34 [interquartile range (IQR) 24-46] years, and 39 patients (52.7%) were male. Median follow-up duration was 36 (IQR 12-60) months, and median TCS was 3 (IQR 1-5). Overall, 19 patients (25.7%) experienced primary composite outcome. Multivariate Cox regression model showed that only hemoglobin [adjusted HR (aHR) 0.67, 95% confidence interval 0.46-0.97, P = .035] predicted primary composite outcome, and TCS fell short of the statistical significance (aHR 1.26, 0.97-1.64, P = .08). Receiver operating characteristic analysis demonstrated that TCS showed an area under the curve value of 0.68 (0.56-0.78, P = .028) in discriminating primary composite outcome at 3 years, and 3-year kidney survival was lower in patients with TCS ≥4 (72.4%) compared with TCS <4 (91.1%) in Kaplan-Meier analysis (P = .036).
Conclusions:
Low hemoglobin levels predicted dismal outcomes in patients with C3G. TCS ≥4 was associated with a worse 3-year kidney survival, which validated the 3-year prognostic value of the TCS of C3G-HI in our population.
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