A clinicopathological comparison between IgA nephropathy and Henoch–Schönlein purpura nephritis in children: use of the Oxford classification

Li, Xue–Qian; Tang, Mengmeng; Yao, Xingfeng; Zhang, Nan; Fan, Jianfeng; Zhou, Nan; Sun, Qiang; Chen, Zhi; Meng, Qun; Lei, Lei; Zhang, Hejia; Chen, Ling; Hua, Lin; Chen, Xiangmei; Liu, Xiaorong

doi:10.1007/s10157-019-01777-8

Cited by 16 publications

(18 citation statements)

References 27 publications

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“…In contrast, another study has shown that patients with a higher percentage of global glomerulosclerosis have more proteinuria 14 . IgAN with proteinuria of the nephrotic range had more global glomerulosclerosis 27 , showing concordance with our findings that patients with GSG abnormal for age had more proteinuria. Because global glomerulosclerosis associated with aging does not affect proteinuria 12 , these findings suggested that the relationship between proteinuria and global glomerulosclerosis might be associated with the pathophysiology of the disease itself.…”

Section: Discussionsupporting

confidence: 92%

“…Because global glomerulosclerosis associated with aging does not affect proteinuria 12 , these findings suggested that the relationship between proteinuria and global glomerulosclerosis might be associated with the pathophysiology of the disease itself. A recent study has shown that specific type of global glomerulosclerosis, solidification rather than obsolescence, is associated with IgAN-related clinical parameters 27 .…”

Section: Discussionmentioning

confidence: 99%

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Age-adjusted global glomerulosclerosis predicts renal progression more accurately in patients with IgA nephropathy

Chung

Lee

Jang

et al. 2020

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The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN). Based on the upper reference limit (95 th percentile) for the number of globally sclerotic glomeruli (GSG) expected on biopsy according to age, we evaluated whether the prognosis of IgAN was affected by the agecalibrated numbers of GSG independent of the Oxford classification. Patients diagnosed with IgAN on renal biopsy in a single center from January 2011 to December 2018 were analyzed retrospectively. patients with more GSG number than the upper reference limit expected on biopsy according to age were categorized in a group of GSG abnormal for age. We analyzed in two ways, calculating the median rate of decline in estimated glomerular filtration rate (eGFR) and time-to-event defined as a decline of eGFR level to 40% lower than the baseline. There were 111 patients in the group of GSG abnormal for age. In this group, the rate of eGFR decline was faster by 1.85 (3.68-0.03) ml/min/1.73 m 2 per year in the fully-adjusted robust regression model. The adjusted hazard ratio for eGFR decline for renal outcome was 29.10 (2.18-388.49). The cumulative incidence of CKD progression was significantly higher, especially for those with T score of 0 in the Oxford classification. We suggest that GSG abnormal for age is an independent risk factor in predicting the renal outcome of IgAN.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Age-adjusted global glomerulosclerosis predicts renal progression more accurately in patients with IgA nephropathy

Chung

Lee

Jang

et al. 2020

Sci Rep

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“…Patients with IgAVN were excluded from the analysis during the formulation of the Oxford-MEST classification. Since, crescents (extracapillary hypercellularity) were not incorporated in the original Oxford classification, subsequent to the publication of the Oxford-MEST classification, various investigations were conducted, which highlighted the significance of crescents (31). Accordingly, the scoring of crescents was also added as an Oxford classification parameter and a factor of predictive value resulting in the modification of MEST score to the MEST-C scores (32).…”

Section: Discussionmentioning

confidence: 99%

“…The risk of development of CKD in individuals with IgAVN ranges from 5% to 20% in children and approaches 30% in adults. Given that various clinical and laboratory parameters, like the quantity of proteinuria, deranged kidney function, and presence of hypertension at initial admission, have been detected as risk factors for CKD in IgAVN, the morphologic lesions of the glomeruli and the tubulointerstitial compartment and also of vessels, would also be of great importance as prognostic parameters in clinical practice (30)(31)(32)(33)(34). Additionally, morphologic lesions on histology are a principal feature to determine the use of immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the IgAN Network (IgANN) working group does not advocate application of Oxford MEST-C score in IgAVN, since their cases did not include IgAV cases and exclusively included IgAN cases (31)(32)(33)(34). Hence, with the latest update to the Oxford score, further studies on the clinical significance of the updated components in IgAVN are warranted, together with other currently used classifications (31)(32)(33)(34)(35)(36). Recently, to detect the usefulness of the Oxford MEST-C classification in children with IgAVN, 58 male and 46 female children (104 children) aged 4-17 years (median age of 10 years) were studied.…”

Section: Discussionmentioning

confidence: 99%

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Predicting renal outcomes in immunoglobulin A vasculitis nephritis; from ISKDC classification to Oxford MEST-C classification

Sepahi

Mubarak

2019

J Renal Inj Prev

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Immunoglobulin A vasculitis nephritis (IgAVN) or Henoch-Schönlein purpura nephritis (HSPN) is the most common type of secondary IgA nephropathy (IgAN), particularly in children. Overall, its prognosis is good, but in a significant number of cases, it does lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Various classifications exist to predict the long-term outcome of kidney disease in these diseases, but none is universally accepted. We searched PubMed, Web of Science Embase, EBSCO, Scopus and directory of open access journals (DOAJ) with keywords of Henoch-Schönlein purpura nephritis, immunoglobulin A vasculitis nephritis, immunoglobulin A nephropathy, IgA vasculitis, extracapillary proliferation, IgA nephropathy, leukocytoclastic vasculitis, endstage renal disease, Oxford classification, crescent and childhood IgA vasculitis. IgAVN in children presents most often with crescents and endocapillary proliferation, with relapsing and remitting course clinically. Due to morphological resemblance of IgAVN and IgAN, the Oxford MEST-C scores could be applied for determining the long-term outcomes in the former disease. A critical concern in applying Oxford classification for IgAVN is that limited number of children with IgAVN exists in any one center and also a relatively short period of follow-up. Hence, further work in this regard is necessary. Preliminary evidence suggests that Oxford MEST-C classification is valid in predicting long-term kidney outcomes in children with IgAVN and the classification can also be used in adults. However, further, large scale, multicenter, international collaborative studies are needed to address the unmet issues.

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Contrast-enhanced ultrasonography for assessing histopathology in pediatric immunoglobulin A nephropathy and Henoch–Schönlein purpura nephritis

et al. 2022

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Background Glomerular disease, including immunoglobulin A nephropathy (IgAN) and Henoch–Schönlein purpura nephritis, is one of the most common kidney diseases in children. The diagnosis of these diseases depends on pathological biopsy, although this procedure is seriously limited by its invasive and high-risk nature. Objective To investigate the potential of contrast-enhanced ultrasonography (CEUS) for evaluating the histopathological severity of IgAN and Henoch–Schönlein purpura nephritis (HSPN). Materials and methods We investigated a total of 13 children with IgAN and 12 children with HSPN confirmed by renal histopathology. We reevaluated the pathological lesions of the children according to the Oxford classification and the Lee grading system and then all the children underwent CEUS. Using SonoLiver software, we constructed time–intensity curves of CEUS for regions of interest in the renal cortex. We analyzed CEUS quantitative parameters for IgAN and HSPN and used Spearman correlation analysis to examine the correlation between CEUS parameters and clinicopathological indexes in the study cohort. Results The CEUS parameters rise time (RT) and time to peak (TTP) were significantly higher in children with Lee grade IV than in those with Lee grades II or III. Spearman correlation analysis revealed a positive correlation between rise time and time to peak with Lee grade in the overall cohort of children, and a positive correlation between rise time and time to peak and severity of crescents in the Oxford classification scoring system. Conclusion Contrast-enhanced US may be used as a noninvasive imaging technique to evaluate the severity of renal pathology and formation of crescents in children with IgAN and HSPN.

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A clinicopathological comparison between IgA nephropathy and Henoch–Schönlein purpura nephritis in children: use of the Oxford classification

Cited by 16 publications

References 27 publications

Age-adjusted global glomerulosclerosis predicts renal progression more accurately in patients with IgA nephropathy

Age-adjusted global glomerulosclerosis predicts renal progression more accurately in patients with IgA nephropathy

Predicting renal outcomes in immunoglobulin A vasculitis nephritis; from ISKDC classification to Oxford MEST-C classification

Contrast-enhanced ultrasonography for assessing histopathology in pediatric immunoglobulin A nephropathy and Henoch–Schönlein purpura nephritis

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