The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults

Coppo, Rosanna; Troyanov, Stéphan; Camilla, Roberta; Hogg, Ronald J.; Cattran, Daniel C.; Cook, H. Terence; Feehally, John; Roberts, Ian S.; Amore, Alessandro; Alpers, Charles E.; Barratt, Jonathan; Berthoux, F; Bonsib, Stephen M.; Bruijn, Jan A.; D’Agati, Vivette D.; D’Amico, Giuseppe; Emancipator, Steven N.; Emma, Francesco; Ferrario, Franco; Fervenza, Fernando C.; Florquin, Sandrine; Fogo, Agnes B.; Geddes, Colin C.; Groene, Hermann Josef; Haas, Mark; Herzenberg, Andrew M.; Hill, Prue; Hsu, Stephen I‐Hong; Jennette, J. Charles; Joh, Kensuke; Julian, Bruce A.; Kawamura, Tetsuya; Lai, Fernand Mac‐Moune; Li, Lei S.; Li, Philip K.; Liu, Zhi H.; Mezzano, Sergio; Schena, Francesco Paolo; Tomino, Yasuhiko; Walker, Patrick D.; Wang, Haiyan; Weening, Jan J.; Yoshikawa, Norishige; Zhang, Hong

doi:10.1038/ki.2010.43

Cited by 181 publications

(123 citation statements)

References 18 publications

(19 reference statements)

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“…For each child, the SD score for MAP was calculated and used to normalize MAP to adult values. 29,30 MAP was calculated as 1/3 of the pulse pressure (systolic blood pressure-diastolic blood pressure) plus diastolic blood pressure. MAP was adjusted in children to .130/80 mmHg in case of an MAP SD score .1.…”

Section: Methodsmentioning

confidence: 99%

“…MAP was adjusted in children to .130/80 mmHg in case of an MAP SD score .1. 29 The outcomes were the rate of renal function decline (slope of eGFR) and the combined outcome of a 50% reduction in renal function over time or ESRD, defined as eGFR,15 ml/min per 1.73 m 2 . We also addressed, as a surrogate outcome, the proportion of individuals with an initial proteinuria.1 g/d that achieved proteinuria,1 g/d during follow-up.…”

Section: Methodsmentioning

confidence: 99%

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Corticosteroids in IgA Nephropathy

Tesař

Troyanov

Bellur

et al. 2015

Journal of the American Society of Nephrology

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198

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Current guidelines suggest treatment with corticosteroids (CS) in IgA nephropathy (IgAN) when proteinuria is persistently $1 g/d despite 3-6 months of supportive care and when eGFR is .50 ml/min per 1.73 m 2 . Whether the benefits of this treatment extend to patients with an eGFR#50 ml/min per 1.73 m 2 , other levels of proteinuria, or different renal pathologic lesions remains unknown. We retrospectively studied 1147 patients with IgAN from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort classified according to the Oxford-MEST classification and medication used, with details of duration but not dosing. Overall, 46% of patients received immunosuppression, of which 98% received CS. Treated individuals presented with greater clinical and pathologic risk factors of progression. They also received more antihypertensive medication, and a greater proportion received renin angiotensin system blockade (RASB) compared with individuals without immunosuppressive therapy. Immunosuppression was associated with a significant reduction in proteinuria, a slower rate of renal function decline, and greater renal survival. Using a propensity score, we matched 184 subjects who received CS and RASB to 184 patients with a similar risk profile of progression who received only RASB. Within this group, CS reduced proteinuria and the rate of renal function decline and increased renal survival. These benefits extended to those with an eGFR#50 ml/min per 1.73 m 2 , and the benefits increased proportionally with the level of proteinuria. Thus, CS reduced the risk of progression regardless of initial eGFR and in direct proportion to the extent of proteinuria in this cohort.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Corticosteroids in IgA Nephropathy

Tesař

Troyanov

Bellur

et al. 2015

Journal of the American Society of Nephrology

Self Cite

198

161

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“…Extracapillary crescents are not included in the Classification because of their scarcity in the study population. In subsequent studies, the value of this histological classification has also been shown for pediatric IgAN patients [21], but to date it has not been evaluated in HSPN patients. Since the publication of the International Study of Kidney Disease in Children (ISKDC) classification [22], in HSPN, the percentage of crescents has been used for estimating disease severity and predicting outcome.…”

Section: Renal Biopsy Findingsmentioning

confidence: 99%

Henoch–Schönlein purpura nephritis

Pöhl

2014

Pediatr Nephrol

124

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Henoch-Schönlein purpura (HSP) is the one of most common types of systemic vasculitis in childhood. Glomerulonephritis (HSPN) occurs in 30-50 % of HSP patients, mostly in a mild form but a small percentage of patients present with nephrotic syndrome or renal failure. HSPN is caused by the glomerular deposition of immunoglobulin A1 (IgA1)-containing immune complexes in the mesangium, the subepithelial and the subendothelial space. Formation of the IgA1 immune complex is thought to be the consequence of aberrantly glycosylated IgA1 molecules secreted into the circulation and their subsequent recognition by IgG specific for galactose-deficient IgA1. Mesangial proliferation and renal damage are triggered by the deposited immune complexes, which likely require activation of the complement system. Whereas other organ manifestations of HSP are mostly benign and self-limiting, HSPN might lead to chronic renal disease and end stage renal failure, thereby justifying immunosuppressive treatment. Long-term renal outcome correlates to the severity of the initial clinical presentation and the extent of renal biopsy changes, both of which are used to decide upon a possible treatment. As there are no evidence-based treatment options for severe HSPN, a large variety of therapeutic regimens are used. Prospective randomized controlled treatment studies are needed, but the low incidence of severe HSPN renders such studies difficult.

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“…For example, when the predictive value of the Oxford classification system for IgA nephropathy was applied to children, there was inconsistent association of the pathologic criteria with renal outcomes (11)(12)(13)(14)(15). Therefore, we sought to validate this new pathologic classification of ANCA GN in cases with childhood onset and determine the association with renal outcomes.…”

Section: Introductionmentioning

confidence: 99%

The New Histopathologic Classification of ANCA-Associated GN and Its Association with Renal Outcomes in Childhood

Noone¹,

Twilt²,

Hayes³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives A proposed histopathologic classification for ANCA-associated GN is predictive of long-term renal outcome in adult populations. This study sought to validate this system in a pediatric cohort.Design, setting, participants, & measurements This was a retrospective, single-center, cohort study of 40 children diagnosed and followed until their transition to adult care at one institution between 1987 and 2012. Renal biopsy specimens were reviewed by a pathologist blinded to patient outcome and were classified using the new histopathologic classification system of focal, crescentic, mixed, and sclerotic groups. Time to the composite outcome of CKD stages 3 and 4 (determined by eGFR with repeated creatinine measures using the Schwartz equation) or ESRD (defined as dialysis dependence or transplantation) were ascertained.Results The study population consisted of 40 children (70% female), followed for a median of 2.4 years. The biopsy specimens were categorized as focal in 13 patients (32.5%), crescentic in 20 (50%), mixed in two (5%), and sclerotic in five (12.5%). Mixed and crescentic were combined for analyses. Survival analysis of time to the composite renal endpoint of at least 3 months of eGFR,60 ml/min per 1.73 m 2 or ESRD differed significantly among the three biopsy groups log-rank P,0.001), with an adjusted hazard ratio of 3.14 (95% confidence interval, 0.68 to 14.4) in the crescentic/mixed group and 23.6 (95% confidence interval, 3.9 to 144.2) in the sclerotic category compared with the focal category. The probability of having an eGFR.60 ml/min per 1.73 m 2 at 2 years was 100% for the focal, 56.5% for the crescentic/mixed, and 0% for the sclerotic biopsy categories.Conclusions This study showed the clinical utility of this histopathologic classification system and its ability to discriminate renal outcomes among children with ANCA GN.

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The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults

Cited by 181 publications

References 18 publications

Corticosteroids in IgA Nephropathy

Corticosteroids in IgA Nephropathy

Henoch–Schönlein purpura nephritis

The New Histopathologic Classification of ANCA-Associated GN and Its Association with Renal Outcomes in Childhood

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