Predictive Capabilities of Three Widely Used Pathology Classification Systems and a Simplified Classification (Beijing Classification) in Primary IgA Nephropathy

Background/Aims: Several pathological classification systems were commonly used in clinical practice to predict the prognosis of IgA nephropathy (IgAN). However, how prognostic value differs between these systems is unclear. The aim of this study was to compare the Lee grade, the Oxford classification, and the Haas classification and to find a simplified classification. Methods: We retrospectively analyzed IgAN cases diagnosed between January 2002 and December 2007. The endpoints were progression to end-stage renal disease (ESRD) or a ≥50% decline in estimated glomerular filtration rate (eGFR). The predictive capabilities were evaluated by comparing the ability of discrimination (continuous net reclassification) and calibration (Akaike information criterion [AIC]). Results: A total of 412 IgAN patients were included in the study. The average follow-up period was 80.62 ± 23.63 months. A total of 44 (10.68%) patients progressed to ESRD, and 70 (16.99%) patients showed a ≥50% decline in eGFR. All multivariate Cox regression models had limited power for high AIC values. The prognostic values of the Lee grade and the Oxford classification were higher than those of models containing only established baseline clinical indicators for progression to ESRD or a ≥50% decline in eGFR (Lee grade 0.50, 95% CI 0.21–0.74; Oxford classification 0.48, 95% CI 0.28–0.71). The prognostic value of the Haas classification was lower than that of the other pathological classification systems for progression to ESRD or a ≥50% decline in eGFR (Lee grade 0.53, 95% CI 0.23–0.92; Oxford classification 0.59, 95% CI 0.10–0.74). The prognostic value of hierarchical classification (Beijing classification) using M and T lesion was similar to the Oxford classification. Conclusions: Both the Lee grade and the Oxford classification showed incremental prognostic values beyond established baseline clinical indicators. The Haas classification was slightly inferior to the Lee grade and the Oxford classification. The hierarchical classification (Beijing classification) using less pathological parameters does not lose predictive efficiency.

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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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The Correlation Analysis between the Oxford Classification of Chinese IgA Nephropathy Children and Renal Outcome -A retrospective cohort study

10.21203/rs.2.13992/v2 ◽

2020 ◽

Author(s):

Heyan Wu ◽

Zhengkun Xia ◽

Chunlin Gao ◽

Pei Zhang ◽

Xiao Yang ◽

...

Keyword(s):

Iga Nephropathy ◽

Retrospective Cohort ◽

Cox Regression ◽

Cohort Analysis ◽

Low Frequency ◽

Tubulointerstitial Fibrosis ◽

Renal Outcome ◽

Oxford Classification ◽

The Oxford Classification ◽

Stage Renal Disease

Abstract Background: The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with IgA nephropathy, but it lacks large cohort validation in children with IgAN in China. We sought to verify that the MEST-C score can be used to predict the renal outcome of children with IgAN. Methods : A retrospective cohort analysis of data from 1243 Chinese children with IgAN who underwent renal biopsy in Jinling Hospital from January 2000 to December 2017.We studied the relationship between the Oxford Classification and renal outcome [a combined renal endpoint:50% estimated glomerular filtration rate (eGFR) loss or end-stage renal disease (ESRD)]. Results :There were 29% of patients with mesangial proliferation (M1), 35% with endocapillary proliferation (E1),37% with segmental sclerosis/adhesion lesion (S1), 23% with moderate tubulointerstitial fibrosis (T1 26-50% of cortex scarred),4.3% with severe tubulointerstitial fibrosis (T2, >50% of cortex scarred),44% with crescent in< 25% of glomeruli(C1), and 4.6% with crescent in>25% of glomeruli(C2).During a median follow-up duration of 86.8 months,171children (14%) developed ESRD or 50% decline in renal function. An early diagnosis seems to be the major reason for a low frequency of chronic and severe lesions such as S,T and C lesions.In the multivariate Cox regression model, Only S( HR 2.7,95% CI ,1.8～4.2, P ＜0.001) and T lesions ( HR 6.6,95% CI ,3.9～11.3, P ＜0.001) were associated with the rate of eGFR loss in the whole cohort, whereas C lesion showed this association only in patients not treated with immunosuppression. Conclusions We found that S and T lesions were valid in predicting a renal outcome in Chinese IgAN Children.

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Evaluation of Clinical and Pathological Characteristics of Patients with IgA Nephropathy Based on Oxford Classification System: Should Crescents be Included?

BANTAO Journal ◽

10.1515/bj-2017-0003 ◽

2017 ◽

Vol 15 (1) ◽

pp. 10-15

Author(s):

Sibel Ersan ◽

Omur Gokmen Sevindik ◽

Caner Cavdar ◽

Sibel Ada ◽

Aykut Sifil ◽

...

Keyword(s):

Iga Nephropathy ◽

Classification System ◽

Clinical Course ◽

Immunoglobulin A ◽

Classification Systems ◽

Oxford Classification ◽

Crescent Formation ◽

Pathological Characteristics ◽

The Oxford Classification

Abstract Introduction. None of the classification systems in immunoglobulin A (IgA) nephropathy has been widely agreed or implemented by clinicians or pathologists. In order to meet this need, "Oxford Classification System", which is highly reproducible and predictive for clinical course, was developed in 2009. In the present study, we investigated clinical and pathological characteristics of patients with IgA nephropathy based on current classification and the predictivity of crescent presence on prognosis. Methods. The study comprised 40 patients with diagnosis of primary IgA nephropathy on renal biopsy. The biopsy findings and follow-up parameters of patients were retrospectively re-evaluated. Pathological findings were examined based on the Oxford classification system. The presence of crescent formation in the specimens was noted. Results. The presence of crescent formation was predictive of poor prognosis regarding the glomerular filtration rate (eGFR), the level of proteinuria, and mean arterial pressure (MAP). Conclusion: Considering the importance of crescent formation in prediction of the clinical course and need for immunosuppressive therapy, it is suggested that crescent presence can be included in this classification system.

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Prognostic value of the Oxford classification and the Oxford score in IgA nephropathy: A Tunisian study

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.308348 ◽

2020 ◽

Vol 31 (6) ◽

pp. 1366

Author(s):

Hela Jebali ◽

Hiba Ghabi ◽

Ikram Mami ◽

BadrBen Kaab ◽

Liliaben Fatma ◽

...

Keyword(s):

Iga Nephropathy ◽

Prognostic Value ◽

Oxford Classification ◽

The Oxford Classification ◽

Oxford Score

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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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