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

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.