Evidences of histologic Thrombotic Microangiopathy and the impact in renal outcomes of patients with IgA nephropathy

ABSTRACTIntroductionIgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. This paper aims to assess the impact of thrombotic microangiopathy (TMA) in the outcomes of Brazilian patients with IgAN.Materials and MethodsAnalysis of clinical data and kidney biopsy findings from patients with IgAN to assess the impact of TMA on renal outcomes.ResultsThe majority of the 118 patients included were females (54.3%); mean age of 33 years (25;43); hypertension and hematuria were observed in 67.8% and 89.8%, respectively. Median creatinine: 1.45mg/dL; eGFR: 48.8ml/min/1.73m2; 24-hour proteinuria: 2.01g; low serum C3: 12.5%. Regarding to Oxford Classification: M1: 76.3%; E1: 35.6%; S1: 70.3%; T1/T2: 38.3%; C1/C2: 28.8%. Average follow-up: 65 months. Histologic evidence of TMA were detected in 21 (17.8%) patients and those ones presented more frequently hypertension (100% vs. 61%, p <0.0001), hematuria (100% vs 87.6%, p=0.0001), worse creatinine levels (3.8 vs. 1.38 mg/dL, p=0.0001), eGFR (18 vs. 60 ml/min/1.73m2), p =0.0001), low serum C3 (28.5% vs. 10.4%, p =0.003), lower hemoglobin levels (10.6 vs. 12.7g/dL, p<0.001) and platelet counts (207,000 vs. 267,000, p=0.001). Biopsy findings of individuals with TMA revealed only greater proportions of E1 (68% vs. 32%, p = 0.002). Individuals with TMA were followed for less time (7 vs. 65 months, p<0.0001) since they progressed more frequently to chronic kidney disease (CKD) requiring renal replacement therapy (RRT) (71.4% vs. 21,6%, p<0.0001). Male sex, T1/T2, and TMA were independently associated with progression to CKD-RRT.ConclusionsIn this study patients with TMA had worse clinical manifestations and outcomes. In terms of histologic evidence, E1 distinguished patients with TMA from other patients. These findings indicate that vascular compartment may also be a prognostic marker in IgAN patients.

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Renal outcomes in IGa nephropathy: validation of the oxford classification in the Thai population

Pathology ◽

10.1097/01.pat.0000454548.01642.8b ◽

2014 ◽

Vol 46 ◽

pp. S132

Author(s):

Wisit Liwlompaisan ◽

Suchin Worawichawong ◽

Chagriya Kitiyakara

Keyword(s):

Iga Nephropathy ◽

Oxford Classification ◽

Thai Population ◽

Renal Outcomes ◽

The Oxford Classification

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Evidences of histologic thrombotic microangiopathy and the impact in renal outcomes of patients with IgA nephropathy

PLoS ONE ◽

10.1371/journal.pone.0233199 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0233199 ◽

Cited By ~ 1

Author(s):

Precil Diego Miranda de Menezes Neves ◽

Rafael A. Souza ◽

Fábio M. Torres ◽

Fábio A. Reis ◽

Rafaela B. Pinheiro ◽

...

Keyword(s):

Iga Nephropathy ◽

Thrombotic Microangiopathy ◽

Renal Outcomes ◽

The Impact

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Faculty Opinions recommendation of The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162996.628332 ◽

2009 ◽

Author(s):

Heinz Regele

Keyword(s):

Iga Nephropathy ◽

Oxford Classification ◽

Clinicopathological Correlations ◽

The Oxford Classification

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The Oxford Classification of IgA Nephropathy: A Retrospective Analysis

American Journal of Nephrology ◽

10.1159/000332223 ◽

2011 ◽

Vol 34 (5) ◽

pp. 435-444 ◽

Cited By ~ 29

Author(s):

Timothy Yau ◽

Stephen M. Korbet ◽

Melvin M. Schwartz ◽

David J. Cimbaluk

Keyword(s):

Retrospective Analysis ◽

Iga Nephropathy ◽

Oxford Classification ◽

The Oxford Classification

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Grading system utilising the total score of Oxford classification for predicting renal prognosis in IgA nephropathy

Scientific Reports ◽

10.1038/s41598-021-82967-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoei Miyabe ◽

Kazunori Karasawa ◽

Kenichi Akiyama ◽

Shota Ogura ◽

Tomo Takabe ◽

...

Keyword(s):

Iga Nephropathy ◽

Clinical Findings ◽

Grading System ◽

Oxford Classification ◽

Kaplan Meier ◽

Hazard Ratios ◽

The Oxford Classification ◽

Renal Prognosis ◽

Renal Survival Rate

AbstractThe Oxford classification of IgA nephropathy (IgAN) can evaluate each MEST-C score individually. We analysed a new grading system that utilised the total MEST-C score in predicting renal prognosis. Altogether, 871 IgAN patients were classified into three groups using the new Oxford classification system (O-grade) that utilised the total MEST-C score (O-grade I: 0–1, II: 2–4, and III: 5–7 points), and the 10-year renal prognosis was analysed. The clinical findings became significantly severer with increasing O-grades, and the renal survival rate by the Kaplan–Meier method was 94.1%, 86.9%, and 74.1% for O-grades I, II, and III, respectively. The hazard ratios (HRs) for O-grades II and III with reference to O-grade I were 2.8 (95% confidence interval [CI] 1.3–6.0) and 6.3 (95% CI 2.7–14.5), respectively. In the multivariate analysis, mean arterial pressure and eGFR, proteinuria at the time of biopsy, treatment of corticosteroids/immunosuppressors, and O-grade (HR 1.63; 95% CI 1.11–2.38) were the independent factors predicting renal prognosis. Among the nine groups classified using the O-grade and Japanese clinical-grade, the renal prognosis had an HR of 15.2 (95% CI 3.5–67) in the severest group. The O-grade classified by the total score of the Oxford classification was associated with renal prognosis.

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Comments on the Oxford classification of IgA nephropathy

Kidney International ◽

10.1038/ki.2009.341 ◽

2009 ◽

Vol 76 (11) ◽

pp. 1207 ◽

Cited By ~ 1

Author(s):

Gary S. Hill ◽

Dominique Nochy ◽

Khalil El Karoui

Keyword(s):

Iga Nephropathy ◽

Oxford Classification ◽

The Oxford Classification

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Informatics Analysis of Health Indicators and Pathological Manifestations of Foot-Process in Patients with Primary IgA Nephropathy

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3557 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1985-1994

Author(s):

Shanhong Shi ◽

Fang Xing ◽

Weiyuan Lin

Keyword(s):

Iga Nephropathy ◽

Statistical Difference ◽

Lesion Group ◽

Oxford Classification ◽

Clinical Indicators ◽

Mesangial Hypercellularity ◽

Group A ◽

The Oxford Classification ◽

Foot Process ◽

Group B

Objective: This paper focuses on the foot-process in renal biopsies of patients with lgA, and examines their correlation with baseline clinical indicators and pathological manifestations in patients with lgA. Method: A retrospective data of patients who performed renal biopsy proven IgA nephropathy was selected. The patients who reached the agreed standard were grouped based on the degree of foot-process. There were three groups (ABC Groups) (Du, Y. and Huang, C, 2009. The value of proteinuria and foot process fusion in the onset of prognosis of acute kidney disease. Chinese Journal of Integrated Traditional and Western Medicine, 10(1), pp.44-45): group A for patients with no obvious foot-process lesion; group B for patients with segmental foot-process; group C for patients with massive foot-process. The three groups were reviewed in the aspects of baseline clinical indicators and Oxford classification, so as to discover foot-process’ effect on patients with IgA nephropathy. Results: A total of 129 patients with IgA nephropathy were included in the study. Concerning about the clinical baseline indicators related to the degree of foot-process, the 24-hour proteinuria level at admission was statistically significant and positively correlated (r = 0.324, P = 0.000). The comparison between groups showed there was statistically significant difference between group C and group A and group B (P = 0.001, P = 0.035). According to the Oxford Classification, only the differences of mesangial hypercellularity (M) and segmental sclerosis/adhesion (S) were statistically significant (r = 0.239, P = 0.006; r = 0.257, P = 0.003) and were positively correlated. In terms of mesangial hypercellularity (M), the differences between group A and B, group A and C were statistically significant (P = 0.01, P = 0.003). The comparison between group B and group C showed statistical difference (P = −0.031) in segmental sclerosis/adhesion (S). Among the 76 patients with S0 revealed by the Oxford classification, there were 55 patients of glomerulosclerosis, which was positively correlated with the degree of foot process (r = 0.211, P = 0.016). The comparison between group A and group C showed statistical difference (P = 0.014). Conclusion: The severity foot-process was positively correlated with the level of proteinuria. Foot-process is positively related with mesangial hypercellularity, segmental sclerosis and glomerulosclerosis. With more severe the foot-process, there will be more serious mesangial hypercellularity and irreversible glomerular injury. Foot-process is positively correlated with Lee’s Pathological Grading.

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