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Background and hypothesis <p>Histological scores are increasingly used to predict long-term kidney outcomes in glomerulonephritis (GN), but most existing systems are disease-specific or complex, limiting their applicability in routine clinical practice. We aimed to evaluate the prognostic value of a composite histologic score based on universally reported glomerular and interstitial lesions, applied across various GN subtypes.</p> Methods <p>We retrospectively analyzed 343 patients with biopsy-proven GN from a single nephrology center in Romania, with a median follow-up of 56.9 months. A composite histological score was constructed from glomerular and interstitial components routinely reported in pathology. Patients were stratified into tertiles (&lt; 10, 10–15, &gt; 15), and the association with a composite renal outcome (dialysis, kidney transplantation, or ≥ 50% decline in eGFR) was assessed using Cox regression and ROC analysis. Models were adjusted for age, sex, baseline eGFR, proteinuria, and treatment category.</p> Results <p>The composite histological score was independently associated with renal outcome in the overall cohort. Patients in the highest score tertile had a significantly increased risk of progression (HR 2.093, 95%, CI 1,322-3,315). The predictive value was strongest in membranous GN, with hazard ratios of 2.546 and 8.085 for intermediate and high tertiles, respectively. The AUC for the total score was 0.669.</p> Conclusions <p>This composite histological score was associated with adverse renal outcomes across a heterogeneous GN cohort, with its strongest performance observed in membranous nephropathy. Its practicality and reproducibility suggest potential utility as a prognostic tool in this subgroup.</p>

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Prognostic value of a composite histologic score in glomerular diseases: a 10-year single center cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月16日

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  • Andreea Covic,
  • Mihai Onofriescu,
  • Adrian Covic,
  • Ismail Gener,
  • Luminița Voroneanu,
  • Kartik Kalra,
  • Simona Eliza Giusca,
  • Irina-Draga Căruntu

摘要

Background and hypothesis

Histological scores are increasingly used to predict long-term kidney outcomes in glomerulonephritis (GN), but most existing systems are disease-specific or complex, limiting their applicability in routine clinical practice. We aimed to evaluate the prognostic value of a composite histologic score based on universally reported glomerular and interstitial lesions, applied across various GN subtypes.

Methods

We retrospectively analyzed 343 patients with biopsy-proven GN from a single nephrology center in Romania, with a median follow-up of 56.9 months. A composite histological score was constructed from glomerular and interstitial components routinely reported in pathology. Patients were stratified into tertiles (< 10, 10–15, > 15), and the association with a composite renal outcome (dialysis, kidney transplantation, or ≥ 50% decline in eGFR) was assessed using Cox regression and ROC analysis. Models were adjusted for age, sex, baseline eGFR, proteinuria, and treatment category.

Results

The composite histological score was independently associated with renal outcome in the overall cohort. Patients in the highest score tertile had a significantly increased risk of progression (HR 2.093, 95%, CI 1,322-3,315). The predictive value was strongest in membranous GN, with hazard ratios of 2.546 and 8.085 for intermediate and high tertiles, respectively. The AUC for the total score was 0.669.

Conclusions

This composite histological score was associated with adverse renal outcomes across a heterogeneous GN cohort, with its strongest performance observed in membranous nephropathy. Its practicality and reproducibility suggest potential utility as a prognostic tool in this subgroup.