IgA nephropathy: Morphologic predictors of progressive renal disease

Lee, S-M Kurt; Rao, Vijaykumar M.; Franklin, Wilbur A.; Schiffer, Mark S.; Aronson, Andrew J.; Spargo, Benjamin H.; Katz, Adrian I.

doi:10.1016/s0046-8177(82)80221-9

Cited by 287 publications

(180 citation statements)

References 11 publications

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“…The amount of proleinuria and the severity of mesangial sclerotic changes are reported to be the most important faetors in assessing the prognosis of human giomerulonephritis. especially IgA nephropathy [21][22][23][24][25][26][27][28][29]; however, the relationship belween these changes is not completely understood. The mechanisms of proiciiuiria and sclerotic change as a result of mesangial cell injury induced by immune reactions on mesangial eell surfaces are unknown, though both changes were confirmed to be complement-dependent lesions (Table I).…”

Section: Discussionmentioning

confidence: 99%

Quantitative study of mesangial injury with proteinuria induced by monoclonal antibody 1-22-3

Kawachi

Oite

Shimizu

1993

Clinical and Experimental Immunology

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SUMMARYMurine MoAb 1-22-3 has already been reported lo bind lo the mesangial cell surface and to cause transient proteinuria and mesangial morphological changes characterized by mesangiolysis. Subsequent mesangial cell proliferation and mesangial matrix increase by a single i,v, injection. In this study, MoAb-induced glomerulopathy was quantitatively analysed. No correlation between the severity of mesangial morphological changes and the degree of proteinuria was detected (r = 0-190). The minimum dose injected lo induee abnormal proleinuria was 25 ;(g. This dose corresponded to 1-79/(g/2 kidneys 30 min after MoAb injection. The highest average level of proleinuria was observed in rats injected wilh 500/igof MoAb, and less proleinuria was observed in rats injected with lO'O, 5-0 and 20 mg. Although the amounts of kidney-fixing MoAb and the subsequent deposition of rat C3 in the high-dose-injected group were larger Iban in the 500/ig injected group, the numbers of infiltrating inflammatory cells were the same in both groups. No correlations between the degrees of such mediators and proteinuria were observed.

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Section: Discussionmentioning

confidence: 99%

Quantitative study of mesangial injury with proteinuria induced by monoclonal antibody 1-22-3

Kawachi

Oite

Shimizu

1993

Clinical and Experimental Immunology

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“…IgA nephropathy (IgAN), which is characterized by IgA deposition in the glomerular mesangium and is associated with a wide variability of clinical and pathologic presentations, is the most common glomerular disease worldwide (1)(2)(3). Histopathologic lesions have been reported as risk factors for the progression of IgAN (4).…”

Section: Introductionmentioning

confidence: 99%

Pathologic Predictors of Renal Outcome and Therapeutic Efficacy in IgA Nephropathy

Shi

Wang

Jiang

et al. 2011

Clinical Journal of the American Society of Nephrology

143

106

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SummaryBackground and objectives The Oxford classification of IgA nephropathy (IgAN) may aid in predicting prognosis and providing therapeutic strategy but must be validated in different ancestry.Design, setting, participants, & measurements A total of 410 patients with IgAN, enrolled from one of the largest renal centers in China, were evaluated for the predictive value of the Oxford classification to prognosis defined as end stage renal disease. A total of 294 of these patients were prospectively treated with renin-angiotensin system blockade and immunosuppressants sequentially and were evaluated separately to assess the predictive value to therapeutic efficacy (defined as time-averaged proteinuria Ͻ1 g/d). Three pathologists reviewed specimens independently according to the Oxford classification and were blinded to clinical data.Results Segmental glomerulosclerosis and tubular atrophy and interstitial fibrosis were independent predictive factors of end stage renal disease. Patients who had Ͼ25% of glomeruli with endocapillary hypercellularity showed higher proteinuria, lower estimated GFR, and higher mean BP than patients with less endocapillary hypercellularity. Immunosuppressive therapy showed a protective effect to prognosis of endocapillary hypercellularity in patients with endoncapillary hypercellularity could benefit from immunosuppressive therapy. Mesangial hypercellularity and tubular atrophy and interstitial fibrosis were independent factors of inefficiency of renin-angiotensin system blockade alone. Crescents were not significant in predicting prognosis or in therapeutic efficacy. ConclusionsThe Oxford classification may aid in predicting prognosis and providing a therapeutic strategy in Chinese patients with IgAN.

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“…It is noteworthy that few randomized therapeutic trials included pathologic factors as inclusion criteria (2). Many classifications had been proposed over the years, on the basis of either classes or semiquantitative scores (3)(4)(5)(6)(7)(8)(9)(10). These in-house classifications were mostly in use in single centers, making comparisons, at best, difficult.…”

Section: Introductionmentioning

confidence: 99%

The Use of the Oxford Classification of IgA Nephropathy to Predict Renal Survival

Alamartine¹,

Sauron²,

Laurent³

et al. 2011

Clinical Journal of the American Society of Nephrology

136

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SummaryBackground and objectives A new classification for IgA nephropathy was recently proposed, namely the Oxford classification. It established specific pathologic features that predict the risk of progression of renal disease. This classification needs validation in different patient populations. We propose a retrospective study to evaluate the predictive value of the Oxford classification on renal survival defined by doubling creatinine or end-stage renal disease in patients with IgA nephropathy. Design, setting, participants, & measurementsWe included 183 patients with primary IgA nephropathy diagnosed between 1994 and 2005. Mean follow-up time was 77 months. Doubling creatinine occurred in 20% of the patients, and end-stage renal disease occurred in 16%. The biopsies were revisited to apply the Oxford classification. The influence of pathologic features on renal survival was analyzed in univariate and multivariate models. ResultsIn univariate time-dependent analyses, tubular atrophy/interstitial fibrosis, segmental glomerulosclerosis, and endocapillary hypercellularity strongly impacted doubling creatinine or end-stage renal disease. On the contrary, mesangial hypercellularity was not associated with renal outcome. In the multivariate model, only estimated GFR at baseline was a risk factor, pathologic lesions having no independent influence. ConclusionsWe confirm the usefulness of the Oxford classification to establish the renal prognosis of patients with IgA nephropathy, although renal function at baseline seems to be of a greater importance than pathologic lesions.

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IgA nephropathy: Morphologic predictors of progressive renal disease

Cited by 287 publications

References 11 publications

Quantitative study of mesangial injury with proteinuria induced by monoclonal antibody 1-22-3

Quantitative study of mesangial injury with proteinuria induced by monoclonal antibody 1-22-3

Pathologic Predictors of Renal Outcome and Therapeutic Efficacy in IgA Nephropathy

The Use of the Oxford Classification of IgA Nephropathy to Predict Renal Survival

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