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

Abstract

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.

Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch–Schönlein purpura nephritis in adults

“…Of note, in patients with IgA nephropathy, T lesions of the Oxford classification system have been consistently been associated with poor renal outcomes in many validation studies of this classification. [19][20][21][22] Furthermore, chronic lesions such as tubulointerstitial fibrosis have been identified as portending a poor prognosis in patients with Henoch-Schönlein purpura nephritis. 10,11,26 In light of these data, the extent of tubulointerstitial lesions as a pathologic criterion should be included in future classification systems.…”

“…[18][19][20][21][22] This group identified four histopathologic features associated with the progression of kidney disease: mesangial hypercellularity score (M; M0 r0.5, M1 40.5), the presence of endocapillary proliferation (E; E0: absent, E1: present) and segmental glomerulosclerosis/adhesion (S; S0: absent, S1: present), and the severity of tubular atrophy/interstitial fibrosis (T; T0 r25%, T1: 26-50%, T2 450%). Given the histopathological similarities between HenochSchö nlein purpura nephritis and IgA nephropathy, the Oxford classification may be an alternative for predicting long-term outcomes in HenochSchö nlein purpura nephritis.…”

Clinical and histopathologic profile of patients with primary IgA nephropathy seen in a tertiary hospital in India

“…Crescents were not included in this classification. It has been evaluated in multiple population cohorts [18][19][20][21][22][23] including a meta-analysis, but there is a 16 The present study was conducted in a tertiary care teaching hospital in Northern India to characterize the clinical presentation and Oxford classification profile in Indian patients with biopsy verified IgAN.…”

Development and Validation of a Prediction Rule Using the Oxford Classification in IgA Nephropathy

“…They identified four types of lesions as specific pathologic measures or features associated with the development of ESRD and/or halving of the eGFR: the mesangial hypercellularity score (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/ interstitial fibrosis (T) (11). Recent findings have suggested the usefulness of this classification system for predicting kidney prognosis (13)(14)(15)(16). However, the prediction ability of the Oxford classification itself for individual kidney prognosis may be limited because of the difficulty in estimating individuals' absolute risks for future ESRD.…”