The response of the Oxford classification to steroid in IgA nephropathy: a systematic review and meta-analysis

Yang, Panpan; Chen, Xi; Zeng, Lei; Hao, Hua; Xu, Gaosi

doi:10.18632/oncotarget.19574

Cited by 20 publications

(18 citation statements)

References 26 publications

(34 reference statements)

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“…Other outcomes, such as proteinuria remission, were not obtained, and these outcomes may have been associated with the MEST-C scores. The use of treatment agents, such as antihypertensive drugs and steroids, was not considered in multivariate models because of missing values, although these agents have been known to affect the predictability of pathological parameters [15,32]. The results from Korean patients may have limited applicability to Caucasian patients; thus, a current pooled analysis with results from both ethnics may be more generalizable than results from Korean patients alone.…”

Section: Discussionmentioning

confidence: 99%

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Yun

Joo

et al. 2020

BMC Nephrol

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Background: Henoch-Schönlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved. Methods: Two hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged < 18 years (9.2 ± 3.6 years) and 100 adults aged ≥18 years (38.6 ± 18.3 years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail.Results: Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median followup periods of 12 years and 13 years, respectively (maximum 19 years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores. Conclusions: The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.

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Section: Discussionmentioning

confidence: 99%

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Yun

Joo

et al. 2020

BMC Nephrol

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“…Patients with M1, S1, and T1/2 were resistant to steroid/immunosuppressive therapy, and E1 is a better response to steroid therapy than T1/2. 36 …”

Section: Methodsmentioning

confidence: 99%

Comparative Efficacy and Safety of Therapies in IgA Nephropathy: A Network Meta-analysis of Randomized Controlled Trials

Yang

Zou

Xiao

et al. 2018

Kidney International Reports

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The present study aims to compare the relative efficacy and safety of different interventions for IgA nephropathy (IgAN) with proteinuria more than 1 g/d by using network meta-analysis. We searched PubMed, Embase, and the Cochrane Library for studies compared the rate of clinical remission and/or end-stage renal disease (ESRD) and/or serious adverse events in IgAN patients with proteinuria (>1 g/d). The surface under the cumulative ranking area (SUCRA) was calculated to rank the interventions. A total of 21 randomized controlled trials with 1822 participants were included for the comparisons of 7 interventions. The rank of the most effective treatments to induce clinical remission was renin−angiotensin system inhibitors (RASi) plus urokinase, steroid plus tonsillectomy, and RASi plus steroid with a SUCRA of 0.912, 0.710, and 0.583, respectively. As for the prevention of ESRD or doubling of serum creatinine, RASi plus steroid (SUCRA 0.012) was the most effective, followed by RASi (SUCRA 0.282) and steroid (SUCRA 0.494), leaving mycophenolate mofetil as the least effective (SUCRA 0.644). There was no statistical difference among all interventions in the occurrence of serious adverse events. The current network meta-analysis demonstrated for the first time that RASi plus steroid is probably the best therapeutic choice, not only for reducing proteinuria but also for maintaining long-term renal protection.

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“…Intensive immunosuppression [corticosteroid with cyclophosphamide (CTX) or azathioprine] is reserved for patients with crescents in more than half of the glomeruli and rapidly deteriorating renal function [8]. A meta-analysis has shown that IgAN patients with more serious pathological features may be more resistant to steroid therapy than slight ones according to the earlier outlined Oxford classification system [9]. However, the benefits of systemic immunosuppression have been questioned in recently completed trials.…”

Section: Latest Kidney Disease: Improving Global Outcomes (Kdigo) CLImentioning

confidence: 99%

Treatment effects of Chinese medicine (Yi-Qi-Qing-Jie herbal compound) combined with immunosuppression therapies in patients of IgA nephropathy with high-risk of ESRD (TCM-WINE): study protocol for a randomized controlled trial

Shen²

2019

Preprint

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Background: IgA nephropathy (IgAN) is the most common glomerular disease worldwide. It has a high incidence in Asians and is more likely to progress to end-stage renal disease (ESRD). For high-risk IgAN, which is clinically characterized by massive proteinuria and renal dysfunction, however, there has been no international consensus on treatment options. Compared with other developed countries, IgAN patients in China are often found to have severe kidney function loss at initial diagnosis. Yi-Qi-Qing-Jie Formula Granule (a compound recipe of Chinese medicinal herbs, YQF) has shown potential renal protection in our previous clinical studies. To further confirm the efficacy and safety of YQF in the treatment of high-risk IgAN, we design a prospective double-blind randomized placebo-controlled trial. Methods/Design: The TCM-WINE study is a single-center, prospective, double-blind randomized placebo-controlled trial. We plan to randomize 60 participants with biopsy-proven IgAN to YQF combined group (YQF compound, combined with prednisolone, and cyclophosphamide if necessary) and immunosuppression group (placebo-YQF, combined with prednisolone, and cyclophosphamide if necessary). The two groups will enter 48-week in-trial treatment phase and receive post-trial follow-up till study completion (3-year). All patients will receive optimal supportive care. The primary composite outcome is defined as the first occurrence of 40% decrease in estimated glomerular filtration rate (eGFR) from the baseline lasting for 3 months, initiating continuous renal replacement treatment or death due to chronic kidney disease (CKD), during the 3-year study phase. The secondary endpoint events are defined as the mean annual eGFR decline rate (eGFR-Slope, ml/min per 1.73 m2 per year) which is calculated by the eGFR regression curve for each eligible patient, and proteinuria remission (prescribed as proteinuria<0.5g/day) at week 24, 36, 48 during the in-trial phase. The remission rate of symptoms and inflammation status will be evaluated respectively at week 48. Safety monitoring and assessment will be undertaken during the study. Discussion: TCM-WINE study will evaluate effects and safety of YQF combined therapy compared with immunosuppression monotherapy on basis of optimal supportive treatment in high-risk IgAN. The evidence from this study will provide a novel, effective and safe Chinese characteristic therapy for high-risk IgAN patients. Trial registration: Clinicaltrials.gov, identifier: NCT03418779. Registered on 18 June 2018. https://clinicaltrials.gov/show/NCT03418779

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The response of the Oxford classification to steroid in IgA nephropathy: a systematic review and meta-analysis

Cited by 20 publications

References 26 publications

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Comparative Efficacy and Safety of Therapies in IgA Nephropathy: A Network Meta-analysis of Randomized Controlled Trials

Treatment effects of Chinese medicine (Yi-Qi-Qing-Jie herbal compound) combined with immunosuppression therapies in patients of IgA nephropathy with high-risk of ESRD (TCM-WINE): study protocol for a randomized controlled trial

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