A Novel Scoring System Based on Oxford Classification Indicating Steroid Therapy Use for IgA Nephropathy

Abstract

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Rapidly progressive IgA nephropathy with membranoproliferative glomerulonephritis-like lesions in an elderly man following the third dose of an mRNA COVID-19 vaccine: a case report

“…Previous studies indicated a poor renal prognosis for patients with IgA nephropathy who had a rapidly progressive course, tubular atrophy, or MPGN-like changes [ 13 , 27 , 28 ]. One multicenter cohort study of 113 Chinese patients with crescentic IgA nephropathy showed that approximately 70% of patients developed end-stage renal disease within 5 years, regardless of immunosuppressive therapy [ 13 ].…”

“…The initial serum creatinine level strongly predicted ESKD, as > 95% of patients with initial serum creatinine > 6.8 mg/dL developed ESKD during follow-up. Another cohort study of 858 Japanese patients with IgA nephropathy demonstrated a poor response to steroid therapy in patients with renal tubular atrophy [ 27 ]. One study of 27 patients with IgA deposition on immunofluorescence and MPGN features found a poor renal prognosis [ 28 ].…”

Treatment of IgA Nephropathy: A Rapidly Evolving Field

“…T2 lesions have indeed been associated with the absence of response to glucocorticoids in both Asian and Caucasian cohorts. 92,93 The therapeutic responsiveness of S1 lesions is more controversial. A proportion of patients with S1 lesions respond clinically and pathologically to glucocorticoids, 93,[96][97][98] supporting the existence of a specific form of podocytopathy in some IgA nephropathy patients.…”

“…92,93 The therapeutic responsiveness of S1 lesions is more controversial. A proportion of patients with S1 lesions respond clinically and pathologically to glucocorticoids, 93,[96][97][98] supporting the existence of a specific form of podocytopathy in some IgA nephropathy patients. These observations have led to an updated recommendation of the Oxford classification to subclassify S1 lesions according to the presence of signs of podocyte damage, such as podocyte hypertrophy or tip lesions.…”

Individualizing immunosuppressive therapy decision in immunoglobulin A nephropathy and application in a Southeast Asian cohort

“…While other studies have also explored the impact of immunosuppressants on kidney outcomes according to the presence and extent of crescents [ 6 , 7 ], Itami et al . extended the use of kidney histology in individualizing the decision for immunosuppressants by developing the steroid responder score (SRS) and steroid nonresponder score (SNRS) [ 8 ]. Among Japanese patients with IgAN, immunosuppression with steroids for high SRS (presence of three or more of the M, E, S and C components of the Oxford MEST-C score) improved renal survival.…”