Prognostic value of the ratio of globally sclerotic glomeruli in patients with idiopathic IgA nephropathy

IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. We assessed whether the Ratio of Globally Sclerotic Glomeruli (RoGSG) on diagnostic biopsy predicts subsequent kidney outcomes in a nationwide, multi‑center registry. Among 326 adults with idiopathic IgAN (mean age 39.1 ± 12.8 years; 60.1% male), 43 patients (13.2%) met a 5 year composite outcome defined as any of: doubling of serum creatinine or ≥ 50% decline in eGFR from baseline, eGFR < 15 mL/min/1.73 m<sup>2</sup>, or initiation of kidney replacement therapy. Receiver operating characteristic analysis identified a RoGSG cutoff of 28.86% for predicting the composite outcome (AUC 0.917, 95% CI 0.885-0.949; sensitivity 93.0%; specificity 84.5%). Using this threshold, 47.6% of patients with RoGSG ≥ 28.86% versus 1.2% with RoGSG < 28.86% reached the composite outcome. In multivariable models adjusted for clinical and pathologic covariates, high RoGSG, grade 2 tubular atrophy/interstitial fibrosis, and non‑response to initial immunosuppression were independent predictors of adverse outcomes. The prognostic association of RoGSG persisted in key subgroups, including those with nephrotic syndrome and those with initial treatment response. These findings support RoGSG as a readily available histopathologic marker that may improve risk stratification in IgAN; however, prospective studies and external validation in independent cohorts are required before any clinical adoption.

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Journal
Scientific Reports
Published
2026-01-07
DOI
https://doi.org/10.1038/s41598-025-33114-3
Primary Topic
Renal Diseases and Glomerulopathies
Type
article
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article

Prognostic value of the ratio of globally sclerotic glomeruli in patients with idiopathic IgA nephropathy

Sim Kutlay, Necmi Eren, Meryem Keleş, Melike Betül Öğütmen et al.
Scientific Reports
Renal Diseases and Glomerulopathies
article

Prognostic value of the ratio of globally sclerotic glomeruli in patients with idiopathic IgA nephropathy

Sim Kutlay, Necmi Eren, Meryem Keleş, Melike Betül Öğütmen, Kültiğin Türkmen, Şeyda Gül Özcan, Taner Baştürk, Serap Yadigar, Özcan Uzun, Ömer Faruk Akçay, Meltem Gürsu, Kenan Turgutalp, Erkan Dervişoğlu, Dilek Güven Taymez, Murat Hayri Sipahioğlu, Abdulkadir Çelik, Müge Üzerk Kibar, Sena Ulu, Onur Tunca, ERHAN TATAR, Deren Oygar, İlhan Kurultak, Savaş Öztürk, Mahmut Şükrü Gök, Ezgi Çoşkun Yenigün, Mahmud İslam, Bülent Kaya, Di̇lek Torun, HAMAD DHEİR, Müge Doksan, Mehmet Yılmaz, Ramazan Öztürk, Şebnem Karakan, Raife Dilhan Alcelik Karacan, Belda Dursun, Hakki Arikan, Alper Azak, Nedim Selcuk Yilmaz, Zeki Aydin, Sinan Kazan, Rabia Hacer, Mehmet Riza Altiparmak, Zülfükar Yilmaz, Aysegul Oruc, Mehmet Deniz Ayli
article en

Abstract

IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. We assessed whether the Ratio of Globally Sclerotic Glomeruli (RoGSG) on diagnostic biopsy predicts subsequent kidney outcomes in a nationwide, multi‑center registry. Among 326 adults with idiopathic IgAN (mean age 39.1 ± 12.8 years; 60.1% male), 43 patients (13.2%) met a 5 year composite outcome defined as any of: doubling of serum creatinine or ≥ 50% decline in eGFR from baseline, eGFR < 15 mL/min/1.73 m<sup>2</sup>, or initiation of kidney replacement therapy. Receiver operating characteristic analysis identified a RoGSG cutoff of 28.86% for predicting the composite outcome (AUC 0.917, 95% CI 0.885-0.949; sensitivity 93.0%; specificity 84.5%). Using this threshold, 47.6% of patients with RoGSG ≥ 28.86% versus 1.2% with RoGSG < 28.86% reached the composite outcome. In multivariable models adjusted for clinical and pathologic covariates, high RoGSG, grade 2 tubular atrophy/interstitial fibrosis, and non‑response to initial immunosuppression were independent predictors of adverse outcomes. The prognostic association of RoGSG persisted in key subgroups, including those with nephrotic syndrome and those with initial treatment response. These findings support RoGSG as a readily available histopathologic marker that may improve risk stratification in IgAN; however, prospective studies and external validation in independent cohorts are required before any clinical adoption.

Scientific ReportsVol. 16(1)
Sakarya University (TR), Balıkesir University (TR), Dicle University (TR), Trakya University (TR), Ministry of Health (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Izmir University (TR), Ankara University (TR), Bilkent University (TR), University of Health Science (KH), Başkent University (TR), State Hospital (GB), Bezmiâlem Vakıf Üniversitesi (TR), Memorial Ankara Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Necmettin Erbakan University (TR), Sivas State Hospital (TR), Haseki Eğitim ve Araştırma Hastanesi (TR), Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi (TR), Haydarpaşa Numune Eğitim ve Araştırma Hastanesi (TR), Başkent University Hospital (TR), Sağlık Bilimleri Üniversitesi (TR), Ankara Yıldırım Beyazıt University (TR), Şişli Etfal Eğitim ve Araştırma Hastanesi (TR), Afyonkarahisar Sağlık Bilimleri Üniversitesi, Pamukkale University (TR), Mersin Üniversitesi (TR), Kocaeli Üniversitesi (TR), Afyon Kocatepe University (TR), Cukurova University (TR), Istanbul University (TR), Marmara University (TR), University of Health Sciences Antigua (AG), Erciyes University (TR), Gazi University (TR)
Türk Nefroloji Dernegi
Good health and well-being
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Renal Diseases and Glomerulopathies
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