The Oxford Classification of IgA nephropathy:  A review of literature

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.

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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/v1 ◽

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.

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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/v3 ◽

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.

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Reproducibility of the Oxford classification of immunoglobulin A nephropathy, impact of biopsy scoring on treatment allocation and clinical relevance of disagreements: evidence from the VALidation of IGA study cohort

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy337 ◽

2018 ◽

Vol 34 (10) ◽

pp. 1681-1690 ◽

Cited By ~ 8

Author(s):

Shubha S Bellur ◽

Ian S D Roberts ◽

Stéphan Troyanov ◽

Virginie Royal ◽

Rosanna Coppo ◽

...

Keyword(s):

Interstitial Fibrosis ◽

Immunoglobulin A ◽

Study Cohort ◽

Immunoglobulin A Nephropathy ◽

Oxford Classification ◽

Tubular Atrophy ◽

Tubulointerstitial Lesions ◽

The Oxford Classification ◽

The Impact

Abstract Background The VALidation of IGA (VALIGA) study investigated the utility of the Oxford Classification of immunoglobulin A nephropathy (IgAN) in 1147 patients from 13 European countries. Methods. Biopsies were scored by local pathologists followed by central review in Oxford. We had two distinct objectives: to assess how closely pathology findings were associated with the decision to give corticosteroid/immunosuppressive (CS/IS) treatments, and to determine the impact of differences in MEST-C scoring between central and local pathologists on the clinical value of the Oxford Classification. We tested for each lesion the associations between the type of agreement (local and central pathologists scoring absent, local present and central absent, local absent and central present, both scoring present) with the initial clinical assessment, as well as long-term outcomes in those patients who did not receive CS/IS. Results All glomerular lesions (M, E, C and S) assessed by local pathologists were independently associated with the decision to administer CS/IS therapy, while the severity of tubulointerstitial lesions was not. Reproducibility between local and central pathologists was moderate for S (segmental sclerosis) and T (tubular atrophy/interstitial fibrosis), and poor for M (mesangial hypercellularity), E (endocapillary hypercellularity) and C (crescents). Local pathologists found statistically more of each lesion, except for the S lesion, which was more frequent with central review. Disagreements were more likely to occur when the proportion of glomeruli affected was low. The M lesion, assessed by central pathologists, correlated better with the severity of the disease at presentation and discriminated better with outcomes. In contrast, the E lesion, evaluated by local pathologists, correlated better with the clinical presentation and outcomes when compared with central review. Both C and S lesions, when discordant between local and central pathologists, had a clinical phenotype intermediate to double absent lesions (milder disease) and double present (more severe). Conclusion We conclude that differences in the scoring of MEST-C criteria between local pathologists and a central reviewer have a significant impact on the prognostic value of the Oxford Classification. Since the decision to offer immunosuppressive therapy in this cohort was intimately associated with the MEST-C score, this study indicates a need for a more detailed guidance for pathologists in the scoring of IgAN biopsies.

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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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