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

2019 ◽  
Author(s):  
Heyan Wu ◽  
Zhengkun Xia ◽  
Chunlin Gao ◽  
Pei Zhang ◽  
Xiao Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Cohort Analysis ◽  
Immunosuppressive Agents ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Independent Risk Factors

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 would like 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 2000 to 2017 was performed and investigated with glomerular filtration rate (eGFR),24h urine proteinuria(24h-UP)and blood pressure(BP) at biopsy and during follow-up.The renal pathology was based on Oxford Classification of IgAN.Results We confirm that BP was significantly correlated with mesangial hypercellullarity(M), endocapillary hypercellularity(E), tubular atrophy/ interstitial fibrosis(T) and crescents (C) .There was a significant correlation between eGFR and segmental glomerulosclerosis(S), T and C .24h-UP and all pathological indexes were significantly correlated. S and T were shown to be independent risk factors associated with renal outcomes in our group. Kaplan-Meier revealed that M [log-rank, chi-squared(χ2)=14.679, P=0.000 ], S(χ2=31.508,P=0.000),T (χ2=78.893, P=0.000),C(χ2=16.603, P=0.000) were associated with renal outcome.In univariate analyses, M(HR 2.167, 95% CI, 1.445~3.251, P = 0.000),S(HR 3.081, 95% CI, 2.038~4.658, P = 0.000), T(HR 7.911, 95% CI, 4.670~13.400,P = 0.000) and C(HR3.346, 95% CI, 1.818~6.156,P = 0.000) lesions were significant predictors of renal outcome. In a multivariate analysis, only S(HR 2.742, 95% CI, 1.805~4.164,P = 0.000) and T(HR 6.633, 95% CI, 3.897~11.289,P = 0.000)were shown to be independent risk factors .Conclusions We found that S and T lesions were valid in predicting a poor outcome in our group.E, S, T and C lesion were important basis for doctors to choose glucocorticoids and immunosuppressive agents in the treatment of IgAN, while T and C lesion were often the basis for doctors to use RAS blockers cautiously.

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

2020 ◽  
Author(s):  
Heyan Wu ◽  
Zhengkun Xia ◽  
Chunlin Gao ◽  
Pei Zhang ◽  
Xiao Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Iga Nephropathy ◽  
Retrospective Cohort Study ◽  
Cortical Area ◽  
Retrospective Cohort ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
The Oxford Classification

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.

scholarly journals The Oxford Classification of IgA nephropathy: A review of literature

2018 ◽  
Vol 8 (1) ◽  
pp. 1308-1312
Author(s):  
Anil Dev Pant
Keyword(s):  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Asian Population ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Mesangial Proliferation ◽  
Primary Glomerulonephritis ◽  
The World ◽  
The Oxford Classification

IgA nephropathy is one of the commonest forms of primary glomerulonephritis in the world, most commonly among Asian population.  Though usually slowly progressive, it is one of the important causes of chronic renal failure. Abnormal IgA1 are formed which leads to formation of IgG antibodies which deposit in the mesangium.  It presents with synpharyngitic hematuria and can have variable histopathological patterns.  The Oxford classification was devised in order to categorize the histopathological patterns, correlate with clinical course and modify treatment accordingly.  Different histopathological criteria are assessed in the classification, which include mesangial proliferation (M), endocapilary proliferation (E), segmental sclerosis (S), and interstitial fibrosis/tubular atrophy (T).The classification has become widely accepted around the world but still needs further validation studies and incorporation of newer parameters. 

P0440EPIDEMIOLOGICAL AND CLINICAL CHARACTERSTICS OF IGA NEPHROPATHY PATIENTS IN TURKEY: TSN-GOLD WORKING GROUP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Necmi Eren ◽  
Meltem Gursu ◽  
Egemen Cebeci ◽  
Aydin Turkmen ◽  
Hasan Haci Yeter ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Clinical Data ◽  
Working Group ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Pathological Features ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
Glomerular Diseases ◽  
Lower Egfr

Abstract Background and Aims According to the data of the Turkish Society of Nephrology-Glomerular Diseases Working Group (TSN-GOLD Working Group), IgA nephropathy is the most common primary glomerular disease in Turkey. The purpose of this study was to investigate the epidemiological and clinical data of IgA nephropathy patients in Turkey. Method 4399 patients with primary glomerular diseases from 47 centers who were followed up between May 2009 and May 2019 were included in the study conducted by TSN-GOLD Working Group. 524 patients were excluded due to lack of pathological data. Among the remaining patients, demographic, clinical and laboratory data of 994 patients with IgA nephropathy were analyzed. Results The median age of the patients was 37 (28-47) years, and 37.3% of them were female. The laboratory and clinical data at the time of diagnosis is presented in Figure-1, and biopsy indications are described in Figure-2. The median number of glomeruli was 16 (IQR: 3.5-4.3), sclerotic glomeruli was 2 (IQR: 1-5), and segmental sclerotic glomeruli was 1 (IQR: 1-2). Exudative changes, subendothelial and subepithelial deposition were present in 566 patients (56.9%), 46 patients (4.6%) and in 38 patients (3.8%), respectively. 662 (66.1%) and 611 of the patients (61.4%) had tubular atrophy and interstitial fibrosis in varying degrees, respectively. 672 (%67.6) and 416 patients (%41.9) had interstitial inflammation and vascular changes, respectively. In immunofluorescence staining, 18%, 30.1%, 4.4%, 68% of the patients had IgG, IgM, C1q and C3 positivity, respectively. Crescentic glomeruli were detected in 227 patients (3.3 ± 3.1 glomeruli). Patients with crescentic glomeruli had significantly higher proteinuria and lower eGFR than the patients without [2203 mg/day (15-26078) vs 1807 mg/day (15-29112); p=0.001; 55.3 ml/min/1.73 m2 (3.72-141.9) vs 72 ml/min/1.73 m2 (3.84-150.81); p&lt;0.001, respectively]. Oxford classification was applied to 544 patients. Endocapillary hypercellularity (E1), mesengial hypercellularity (M1), tubular atrophy and interstitial fibrosis (T1 and T2), segmental sclerosis (S1) were present in 126 (13%), 425 (42.8%), 306 (30.8%) and 325 patients (%32.7), respectively. Proteinuria levels were higher in patients with endocapillary hypertrophy, mesengial hypercellularity, tubular atrophy-interstitial fibrosis and segmental sclerosis. eGFR levels were lower in patients with endocapillary hypertrophy, tubular atrophy-interstitial fibrosis and segmental sclerosis (Figure-3). Conclusion In this study we found that, the most common presentation of IgA nephropathy patients in our country was asymptomatic urinary abnormalities followed by nephritic and nephrotic syndrome. Higher proteinuria and lower eGFR values in patients with crescentic glomeruli, support the adoption of crescentic lesions in the new Oxford classification (MEST-C) to predict more precise outcome of IgA nephropathy patients. The high number of patients to whom the Oxford classification was applied provided us with the opportunity to examine the clinical reflections of pathological features. Evaluation of the follow-up data of the patients will give us the possibility to reveal the effect of initial clinical and pathological features on clinical findings and renal outcome.

scholarly journals The Relationship between Cigarette Smoking and IgA Nephropathy

2021 ◽  
Author(s):  
Siqing Wang ◽  
Aiya Qin ◽  
Gaiqin Pei ◽  
Zheng Jiang ◽  
Lingqiu Dong ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Iga Nephropathy ◽  
Cox Regression ◽  
Interstitial Fibrosis ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Renal Outcome ◽  
Study Endpoint ◽  
Tubular Atrophy ◽  
Cox Regression Analysis

Abstract Background and aim: Regarding that whether cigarette smoking is associated with the progression of IgA nephropathy (IgAN) remains uncertain, we aimed to evaluate the effect of cigarette smoking on the prognosis of IgAN.Methods: 1239 IgAN patients who meet inclusion criteria from West China Hospital of Sichuan University were divided into smoker and non-smoker group. The endpoint was end stage renal disease (ESRD: eGFR <15 mL/min/1.73 m2 or having renal replacement treatment) and/or eGFR decreased>50%. Kaplan-Meier and Cox proportional hazards analyses were performed. Association of cigarette smoking and IgAN was further verified by propensity-score-matched cohort analysis.Results: During the mean follow-up period of 61 months, 40 out of 209 (19%) patients in smoker group and 110 out of 1030 (11%) in non-smoker group reached study endpoint(p<0.001). Multivariate Cox regression analysis revealed that cigarette smoking (HR=1.58,p=0.043), female gender (HR=2.00,p=0.002), Hypertension (HR=1.50,p=0.029), Serum creatinine (HR=1.01,p<0.001), segmental glomerulosclerosis (HR=1.59,p=0.026), and tubular atrophy/interstitial fibrosis (HR=3.13,p<0.001) were independent risk factors for prediction of poor renal outcome of IgAN. After matching with propensity scores, the significant correlation between cigarette smoking and the renal outcomes of IgAN patients can be seen.Conclusion: Smoking is an independent risk factor for the progression of IgAN, especially for female subjects.

Identifying patients with CKD risk at the time of nephrectomy: When to initiate nephrology consult

2021 ◽  
pp. 239936932110319
Author(s):  
Yihe Yang ◽  
Zachary Kozel ◽  
Purva Sharma ◽  
Oksana Yaskiv ◽  
Jose Torres ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Radical Nephrectomy ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Interstitial Fibrosis ◽  
Kidney Neoplasm ◽  
Tubular Atrophy ◽  
Independent Risk Factors

Introduction: The prevalence of chronic kidney disease (CKD) is high among kidney neoplasm patients because of the overlapping risk factors. Our purpose is to identify kidney cancer survivors with higher CKD risk. Methods: We studied a retrospective cohort of 361 kidney tumor patients with partial or radical nephrectomy. Linear mixed model was performed. Results: Of patients with follow-up >3 months, 84% were identified retrospectively to fulfill criteria for CKD diagnosis, although CKD was documented in only 15%. Urinalysis was performed in 205 (57%) patients at the time of nephrectomy. Multivariate analysis showed interstitial fibrosis and tubular atrophy (IFTA) >25% ( p = 0.005), severe arteriolar sclerosis ( p = 0.013), female gender ( p = 0.024), older age ( p = 0.012), BMI ⩾ 25 kg/m2 ( p < 0.001), documented CKD ( p < 0.001), baseline eGFR ⩽ 60 ml/min/1.73 m2 ( p < 0.001), and radical nephrectomy ( p < 0.001) were independent risk factors of lower eGFR at baseline and during follow-up. Average eGFR decreased within 3 months post nephrectomy. However, patients with different risk levels showed different eGFR time trend pattern at longer follow-ups. Multivariate analysis of time × risk factor interaction showed BMI, radical nephrectomy and baseline eGFR had time-dependent impact. BMI ⩾ 25 kg/m2 and radical nephrectomy were associated with steeper eGFR decrease slope. In baseline eGFR > 90 ml/min/1.73 m2 group, eGFR rebounded to pre-nephrectomy levels during extended follow-up. In partial nephrectomy patients with baseline eGFR ⩾ 90 ml/min/1.73 m2 ( n = 61), proteinuria ( p < 0.001) and BMI ( p < 0.001) were independent risk factors of decreased eGFR during follow up. Conclusions: As have been suggested by others and confirmed by our study, proteinuria and CKD are greatly under-recognized. Although self-evident as a minimum workup for nephrectomy patients to include SCr, eGFR, urinalysis, and proteinuria, the need for uniform applications of this practice should be reinforced. Non-neoplastic histology evaluation is valuable and should include an estimate of global sclerosis% (GS) and IFTA%. Patients with any proteinuria and/or eGFR ⩽ 60 at the time of nephrectomy or in follow-up with urologists, and/or >25% GS or IFTA, should be referred for early nephrology consultation.

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

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.

scholarly journals Urinary Periostin Excretion Predicts Renal Outcome in IgA Nephropathy

2016 ◽  
Vol 44 (6) ◽  
pp. 481-492 ◽  
Author(s):  
Jin Ho Hwang ◽  
Jung Pyo Lee ◽  
Clara Tammy Kim ◽  
Seung Hee Yang ◽  
Jin Hyuk Kim ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Renal Fibrosis ◽  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Glomerular Sclerosis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Matricellular Protein ◽  
Tubular Atrophy ◽  
Renal Outcomes ◽  
Group 3

Background: Periostin is a matricellular protein and plays a vital role in tissue regeneration, fibrosis and wound healing. However, data about its significance in nephrology are limited. We investigated the correlation between urinary periostin excretion and its clinical significance including renal histologic findings and prognosis in IgA nephropathy (IgAN). Methods: Of 399 patients from a glomerulonephritis cohort recruited between January 2009 and December 2014, 314 were enrolled. Serum and urine periostin (uPOSTN) were measured using enzyme-linked immunosorbent assay. We divided the patients into 3 groups by uPOSTN/creatinine (uPOSTN/Cr): group 1 (undetectable), group 2 (lower than the median) and group 3 (higher than the median). Results: The uPOSTN level was correlated with pathologic classifications and both initial and final IDMS-MDRD estimated glomerular filtration rates (eGFRs; p < 0.001). Histologically, group 3 patients were correlated with severe interstitial fibrosis/tubular atrophy (p = 0.004), interstitial inflammation (p = 0.007), hyaline arteriolosclerosis (p = 0.001) and glomerular sclerosis (p < 0.001). A higher initial uPOSTN/Cr level was associated with a greater decline in eGFR during follow-up (p = 0.043 when initial eGFR ≥60; p = 0.025 when eGFR <60 ml/min/1.73 m2), and the renal outcomes with end-stage renal disease (ESRD; p = 0.003), ESRD and/or eGFR decrease of >30% (p = 0.033) and ESRD and/or eGFR decrease of >50% (p = 0.046) occurred significantly more in group 3. In multivariate analysis, uPOSTN group 3 (hazards ratio 2.839, 95% CI 1.013-7.957; p = 0.047) was independently associated with ESRD in IgAN patients. Conclusion: uPOSTN/Cr value at initial diagnosis correlated with renal fibrosis and predicted the renal outcomes in patients with IgAN. It could be a promising urinary biomarker for renal fibrosis.

scholarly journals Evaluation of the Oxford classification in immunoglobulin A vasculitis with nephritis: a cohort study and meta-analysis

2020 ◽  
Author(s):  
Bingxin Yu ◽  
Sufang Shi ◽  
Wanyin Hou ◽  
Lijun Liu ◽  
Jicheng Lv ◽  
...  
Keyword(s):  
Cohort Study ◽  
Interstitial Fibrosis ◽  
Meta Analysis ◽  
Immunoglobulin A ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Tubular Atrophy ◽  
The Oxford Classification ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Similarities in clinicopathological presentations in immunoglobulin A (IgA) nephropathy and IgA vasculitis with nephritis (IgAVN) raise the question of the utility of the Oxford classification in the latter. The aim of this study was to evaluate the Oxford classification in IgAVN. Methods We conducted a retrospective cohort study and meta-analysis following systematic searching of the MEDLINE and Excerpta Medica Database (EMBASE) databases between January 2009 and September 2019. We modeled the association of 30 and 50% decline in estimated glomerular filtration rate or end-stage renal disease with pathologic lesions of the Oxford classification including mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), interstitial fibrosis/tubular atrophy (T) and crescents (C). Results were pooled using random-effects meta-analysis. Results The cohort study included 132 patients, and only T lesion was an independently risk factor in IgAVN. The meta-analysis yielded six retrospective studies with 721 patients and 139 endpoints. In multivariate model, T lesion was significantly associated with renal outcome (hazard ratio = 2.45, P = 0.007). M and C lesions could not predict renal outcome without evidence of heterogeneity. E and S lesions could not predict renal outcome with evidence of heterogeneity (I2 = 66.6%; P = 0.01, and I2 = 65.8%; P = 0.03, respectively). Subgroup analysis showed that the possible reasons to the heterogeneity were from usage of immunosuppressant, sample size and follow-up time. Conclusions The study suggests that the Oxford classification could not be fully validated in IgAVN. Higher portion of immunosuppressant especially before renal biopsy might be the main confounder for the predictive value of Oxford classification in IgAVN.

scholarly journals Novel urinary glycan profiling by lectin array serves as the biomarkers for predicting renal prognosis in patients with IgA nephropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chieko Kawakita ◽  
Koki Mise ◽  
Yasuhiro Onishi ◽  
Hitoshi Sugiyama ◽  
Michihiro Yoshida ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Lectin Binding ◽  
Renal Outcome ◽  
Tubular Atrophy ◽  
Net Reclassification Improvement ◽  
Outcome Group ◽  
Lectin Array ◽  
Renal Prognosis ◽  
Glycan Profiling

AbstractIn IgA nephropathy (IgAN), IgA1 molecules are characterized by galactose deficiency in O-glycans. Here, we investigated the association between urinary glycosylation profile measured by 45 lectins at baseline and renal prognosis in 142 patients with IgAN. The primary outcome was estimated glomerular filtration rate (eGFR) decline (> 4 mL/min/1.73 m2/year), or eGFR ≥ 30% decline from baseline, or initiation of renal replacement therapies within 3 years. During follow-up (3.4 years, median), 26 patients reached the renal outcome (Group P), while 116 patients were with good renal outcome (Group G). Multivariate logistic regression analyses revealed that lectin binding signals of Erythrina cristagalli lectin (ECA) (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.11–7.28) and Narcissus pseudonarcissus lectin (NPA) (OR 2.32, 95% CI 1.11–4.85) adjusted by age, sex, eGFR, and urinary protein were significantly associated with the outcome, and they recognize Gal(β1-4)GlcNAc and high-mannose including Man(α1-6)Man, respectively. The addition of two lectin-binding glycan signals to the interstitial fibrosis/tubular atrophy score further improved the model fitness (Akaike’s information criterion) and incremental predictive abilities (c-index, net reclassification improvement, and integrated discrimination improvement). Urinary N-glycan profiling by lectin array is useful in the prediction of IgAN prognosis, since ECA and NPA recognize the intermediate glycans during N-glycosylation of various glycoproteins.

P0368THE ADDED IMPACT OF CRESCENTS ON DEVELOPMENT OF END-STAGE KIDNEY DISEASE IN COMBINATION WITH OTHER PATHOLOGICAL FEATURES OF OXFORD CLASSIFICATION IN PATIENTS WITH IGA NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shahrzad Ossareh ◽  
Neda Nazemzadeh ◽  
Mojgan Asgari ◽  
Hanri Afghahi
Keyword(s):  
Interstitial Fibrosis ◽  
Renal Outcome ◽  
Pathological Features ◽  
Oxford Classification ◽  
End Stage Kidney Disease ◽  
Tubular Atrophy ◽  
Classification Score ◽  
Increased Risk ◽  
C 30 ◽  
End Stage

Abstract Background and Aims Oxford classification of IgA nephropathy (IgAN) consists of the presence of four key pathologic features: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S) and tubular atrophy and interstitial fibrosis (T). The association between MEST score and renal outcome has been evaluated in previous studies. More recently crescents (C) were added to Oxford classification but the additive effect of the crescents on prediction of renal outcome is less well studied. The aim of the study was to assess the added impact of crescents, as an independent variable, on development of end stage kidney disease (ESKD) in combination with other pathological features of Oxford classification, in patients with IgAN. Method One- hundred fifteen patients with IgAN (76% male, mean age: 37±13 years, mean serum creatinine: 4.0±4.3 mg/dl and mean proteinuria: 3.4±2.5 g/24 hours) were followed for 43±29 months. MEST score was defined according to Oxford classification (M0/M1, E0/E1, S0/S1). To increase the power of the study, T was defined as T0&lt;25% and T1≥ 25%. Crescents were defined as C0: absence and C1: at least one crescents in biopsy. Additionally in sensitivity analysis, the risk of ESKD was estimated at different cut-off levels of at least 10%, 20% and 30% crescents. Furthermore the additive effect of the presence of crescents on the other Oxford classification score was studied. Association between Oxford Classification score and risk of ESKD was examined by time-dependent Cox model to estimate hazard ratio, through univariate and multivariate analyses, adjusted for demographics, laboratory and pathological findings. Kaplan–Meier and the log-rank tests were used to estimate kidney survival. Results During follow-up 40 patients (35%) developed ESKD (dialysis or kidney transplantation). Forty- six patients (40%) had at least one crescent and among them 25 (46%) developed ESKD. In sub- analysis in 11 patients with C≥30%, 7 (66%) developed ESKD. Among 57 patients with T1, 34 (60%) developed ESKD. Twenty- seven patients had both T1 and C1 and among them 20 (74%) developed ESKD. In adjusted model, among patients with crescents, only C≥30% (HR: 3.15, 95% CI 1.15-11.00,P=0.027) and the presence of T1+ C1 (HR: 7.18, 95% CI 1.90-27.10,P=0.004) were associated with increased risk of ESKD and the combinations of M1+C1, E1+C1 or S1+C1 were not significantly associated with increased risk of ESKD (P=0.067, P=0.450, P=0.035, respectively). The median kidney survival was 78.0 months (95% CI, 70.5-85.6 months) with T0+C0 and 32.3 months (95% CI, 19.3-45.3 months) with T1+C1. Conclusion In this study based on Oxford classification, tubular atrophy and interstitial fibrosis≥25%, and presence of crescents≥ 30%, were independently associated with increased risk of ESKD. This risk was strongly increased in combined presence of at least one crescent and T1≥25% and 74% of such patients developed ESKD within a mean interval of 27 months.

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