The correlation analysis between the Oxford classification of Chinese IgA nephropathy children and renal outcome - a retrospective cohort study

Abstract Background: The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with IgA nephropathy (IgAN), but it lacks large cohort validation in children with IgAN in China. We sought to verify whether the Oxford classification could be used to predict the renal outcome of children with IgAN. Methods : A total of 1243 Chinese children with IgAN who underwent renal biopsy in Jinling Hospital were enrolled from January 1, 2000, to December 31, 2017, in this retrospective cohort study. The primary endpoint of the study was a composite of either ≥50% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD). We probed into the relationship between the Oxford classification and renal outcome. Results : There were 29% of children with mesangial proliferation(M1), 35% with endocapillary proliferation (E1), 37% with segmental sclerosis/adhesion lesion (S1), 23% with moderate tubular atrophy/interstitial fibrosis (T1 25–50% of cortical area involved), 4.3% with severe tubular atrophy/interstitial fibrosis (T2 >50% of cortical area involved), 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 7.2 (4.6–11.7) years, 171 children (14%) developed ESRD or 50% decline in eGFR. In the multivariate COX regression model, only segmental sclerosis/adhesion (HR2.7,95%CI 1.8～4.2, P ＜0.001) and tubular atrophy/interstitial fibrosis (HR6.6,95%CI 3.9～11.3, P ＜0.001) were confirmed to be independent risk factors of poor renal outcome in the whole cohort, whereas crescent showed significant association with prognosis only in children received no immunosuppressive treatment.Conclusions: This study revealed that segmental sclerosis/adhesion and tubular atrophy/interstitial fibrosis were independently associated with poor renal outcome in Chinese children with IgA nephropathy.

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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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Reproducibility for pathological prognostic parameters of the Oxford classification of IgA nephropathy: a Japanese cohort study of the Ministry of Health, Labor and Welfare

Clinical and Experimental Nephrology ◽

10.1007/s10157-016-1258-8 ◽

2016 ◽

Vol 21 (1) ◽

pp. 92-96 ◽

Cited By ~ 12

Author(s):

Satoshi Hisano ◽

◽

Kensuke Joh ◽

Ritsuko Katafuchi ◽

Akira Shimizu ◽

...

Keyword(s):

Cohort Study ◽

Iga Nephropathy ◽

Prognostic Parameters ◽

Oxford Classification ◽

Ministry Of Health ◽

Japanese Cohort ◽

The Oxford Classification

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Clinical impact of endocapillary proliferation according to the Oxford classification among adults with Henoch-Schönlein purpura nephritis: a multicenter retrospective cohort study

BMC Nephrology ◽

10.1186/s12882-018-1009-z ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Koji Inagaki ◽

Ahmad Baseer Kaihan ◽

Asaka Hachiya ◽

Takaya Ozeki ◽

Masahiko Ando ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Impact ◽

Oxford Classification ◽

Henoch Schonlein Purpura ◽

The Oxford Classification ◽

Schonlein Purpura ◽

Henoch Schönlein Purpura ◽

Purpura Nephritis

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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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