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Backgrounds <p>The FSTIV score, an acronym derived from Focal, Segmental, Tubular, Interstitial, and Vascular, is a histopathological scoring system based on light microscopy that incorporates four parameters: focal segmental glomerulosclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF), and vascular hyalinosis (VH). This study aimed to investigate the associations among the FSTIV score, clinicopathological characteristics, and initial treatment response in patients with idiopathic membranous nephropathy (IMN).</p> Methods <p>We retrospectively enrolled 139 patients with biopsy-proven IMN from a single center between June 2019 and September 2023. The FSTIV score was calculated using four histological parameters (FSGS, TA, IF, and VH). Patients were categorized into four groups according to their FSTIV scores. Logistic regression analysis was performed to identify risk factors for elevated FSTIV score. The impact of histology on treatment response within 6 months after renal biopsy was evaluated.</p> Results <p>Higher FSTIV scores were associated with older age, a greater prevalence of hypertension and nephrotic syndrome, and worse renal function. Across increasing FSTIV categories, the prevalence of each individual component (FSGS, TA, IF, and VH) showed a stepwise increase.Logistic regression analysis identified hypertension (OR = 2.460, 95%CI: 1.202–5.208) and 24-hour proteinuria (OR = 1.0001, 95%CI: 1.0000-1.0002) as independent predictors of higher FSTIV scores. The remission rates within 6 months after renal biopsy decreased significantly with increasing FSTIV scores (87.5%, 61.8%, 39.0% vs. 76.4%; <i>P</i> &lt; 0.001), indicating a diminished response to immunosuppressive therapy.</p> Conclusions <p>Higher FSTIV scores were associated with more severe clinical and pathological presentations in IMN patients. Hypertension and 24-hour proteinuria were independent risk factors for an increased FSTIV score, which correlated with a poorer response to treatment and lower remission rates. The FSTIV score serves as a valuable tool for assessing disease severity, guiding treatment decisions, and predicting renal outcomes in patients with IMN.</p> Clinical trial <p>Not applicable.</p>

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FSTIV score is essential for clinical management and predicts outcome of idiopathic membranous nephropathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月12日

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  • Yonghua Liu,
  • Mei Wang,
  • Lirong Yang,
  • Jia Ma,
  • Guoqing Zhang,
  • Li Bao,
  • Ling Ma,
  • Wenbo Xia,
  • Yali Zheng

摘要

Backgrounds

The FSTIV score, an acronym derived from Focal, Segmental, Tubular, Interstitial, and Vascular, is a histopathological scoring system based on light microscopy that incorporates four parameters: focal segmental glomerulosclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF), and vascular hyalinosis (VH). This study aimed to investigate the associations among the FSTIV score, clinicopathological characteristics, and initial treatment response in patients with idiopathic membranous nephropathy (IMN).

Methods

We retrospectively enrolled 139 patients with biopsy-proven IMN from a single center between June 2019 and September 2023. The FSTIV score was calculated using four histological parameters (FSGS, TA, IF, and VH). Patients were categorized into four groups according to their FSTIV scores. Logistic regression analysis was performed to identify risk factors for elevated FSTIV score. The impact of histology on treatment response within 6 months after renal biopsy was evaluated.

Results

Higher FSTIV scores were associated with older age, a greater prevalence of hypertension and nephrotic syndrome, and worse renal function. Across increasing FSTIV categories, the prevalence of each individual component (FSGS, TA, IF, and VH) showed a stepwise increase.Logistic regression analysis identified hypertension (OR = 2.460, 95%CI: 1.202–5.208) and 24-hour proteinuria (OR = 1.0001, 95%CI: 1.0000-1.0002) as independent predictors of higher FSTIV scores. The remission rates within 6 months after renal biopsy decreased significantly with increasing FSTIV scores (87.5%, 61.8%, 39.0% vs. 76.4%; P < 0.001), indicating a diminished response to immunosuppressive therapy.

Conclusions

Higher FSTIV scores were associated with more severe clinical and pathological presentations in IMN patients. Hypertension and 24-hour proteinuria were independent risk factors for an increased FSTIV score, which correlated with a poorer response to treatment and lower remission rates. The FSTIV score serves as a valuable tool for assessing disease severity, guiding treatment decisions, and predicting renal outcomes in patients with IMN.

Clinical trial

Not applicable.