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NDT Advance Access published online on December 23, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh633
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Nephrol Dial Transplant © ERA-EDTA 2004; all rights reserved
Received July 2, 2004
Accepted November 10, 2004

Original Articles

Histological grading of IgA nephropathy predicting renal outcome: revisiting H. S. Lee's glomerular grading system

Hyun Soon Lee 1*, Myung Suk Lee 2, Sa Min Lee 2, Sang Yun Lee 2, Eun Sun Lee 2, Eun Young Lee 2, So Yeon Park 1, Jin Suk Han 3, Sungkwon Kim 3, and Jung Sang Lee 3

1 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
2 Seoul National University College of Medicine, Seoul, Korea; Sophomore medical students, who joined this study during their elective course work
3 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

* To whom correspondence should be addressed.
Hyun Soon Lee, E-mail: hyunsoon{at}plaza.snu.ac.kr



  Abstract

Background. The glomerular grading system is useful to compare biopsy specimens and to predict the natural course of disease in IgA nephropathy (IgAN), although no grading system can be perfect.

Methods. H. S. Lee's grading system for IgAN was refined as follows: grade I, normal or focal mesangial cell proliferation; grade II, diffuse mesangial cell proliferation, or <25% of glomeruli with crescent (Cr)/segmental sclerosis (SS)/global sclerosis (GS); grade III, 25-49% of glomeruli with Cr/SS/GS; grade IV, 50-75% of glomeruli with Cr/SS/GS; grade V, >75% of glomeruli with Cr/SS/GS. This refined H. S. Lee grading system was then tested for clinical relevance on 187 patients with IgAN followed up for an average of 6.5 years (minimum, 3 years). In the survival analysis, a modified primary end-point (progressive renal disease) was used.

Results. The glomerular grades were significantly related to hypertension, serum creatinine levels and the amounts of proteinuria at time of biopsy. By univariate analysis, glomerular grades, hypertension, renal insufficiency and significant proteinuria (≥1 g/day) were significantly associated with progressive renal disease. By multivariate analysis using the Cox regression model, glomerular grades, renal insufficiency and significant proteinuria were independent prognostic factors for progressive renal disease. At the end of follow-up, glomerular grades were significantly related to serum creatinine levels, amounts of proteinuria, hypertension and progressive renal disease.

Conclusions. These findings indicate that the refined H. S. Lee grading system for IgAN is useful in assessing the patients’ clinical outcome and is sufficiently simple and easy to reproduce as to be universally applicable in prognostic work.

Keywords: H. S. Lee's glomerular grading system; IgA nephropathy; prognosis; progressive renal disease; renal survival.
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