A Novel Simpler Histological Classification for Renal Survival in IgA Nephropathy: A Retrospective Study

Manno, Carlo; Strippoli, Giovanni F.M.; D’Altri, Christian; Torres, Diletta Domenica; Rossini, Michele; Schena, Francesco Paolo

doi:10.1053/j.ajkd.2007.03.013

Cited by 145 publications

(109 citation statements)

References 33 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…Many epidemiologic studies have identified risk factors for poor kidney prognosis in patients with IgAN, including age (2), sex (3), hypertension (3,4), decreased estimated GFR (eGFR) (2)(3)(4)(5), proteinuria (2,3,(6)(7)(8), and pathologic severity (2,9,10). In 2009, the Oxford classification of IgAN was proposed by an international working group (11,12).…”

Section: Introductionmentioning

confidence: 99%

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

Tanaka

Ninomiya

Katafuchi

et al. 2013

Clinical Journal of the American Society of Nephrology

108

View full text Add to dashboard Cite

SummaryBackground and objectives The risk assessment for developing ESRD remains limited in patients with IgA nephropathy (IgAN). The aim of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with IgAN.Design, setting, participants, & measurements A total of 698 patients with IgAN diagnosed by renal biopsy at Kyushu University Hospital (derivation cohort) between 1982 and 2010 were retrospectively followed. The Oxford classification was used to evaluate the pathologic lesions. The risk factors for developing ESRD were evaluated using a Cox proportional hazard model with a stepwise backward elimination method. The prediction rule was verified using data from 702 patients diagnosed at Japanese Red Cross Fukuoka Hospital (validation cohort) between 1979 and 2002.Results In the derivation cohort, 73 patients developed ESRD during the median 4.7-year follow-up. The final prediction model included proteinuria (hazard ratio [HR], 1.30; 95% confidence interval [95% CI], 1.16 to 1.45, every 1 g/24 hours), estimated GFR (HR, 0.84; 95% CI, 0.74 to 0.96, every 10 ml/min per 1.73 m 2 ), mesangial proliferation (HR, 1.85; 95% CI, 1.10 to 3.11), segmental sclerosis (HR, 3.21; 95% CI, 1.37 to 7.51), and interstitial fibrosis/tubular atrophy (T1: HR, 5.30; 95% CI, 2.63 to 10.7; T2: HR, 20.5; 95% CI, 9.05 to 46.5) as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The incidence of ESRD increased linearly with increases in the total risk scores (P for trend ,0.001). Furthermore, the prediction rule demonstrated good discrimination (c-statistic=0.89) and calibration (Hosmer-Lemeshow test, P=0.78) in the validation cohort.Conclusions This study developed and validated a new prediction rule using clinical measures and the Oxford classification for developing ESRD in patients with IgAN.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Tanaka

Ninomiya

Katafuchi

et al. 2013

Clinical Journal of the American Society of Nephrology

108

View full text Add to dashboard Cite

show abstract

“…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

139

View full text Add to dashboard Cite

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.

show abstract

“…The biopsies were classified into grades I, II, or III in increasing order of severity according to a three-grade histological classification. 10 Grade I indicated the presence of normal glomeruli or slight increase in mesangial matrix and/or cellularity without tubulointerstitial changes. Grade II denoted a moderate degree of mesangial proliferation and/or focal segmental sclerosis and/or cellular crescents up to 50% of glomeruli, and tubule atrophy and interstitial fibrosis up to 1/3 of cortical area.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran

et al. 2011

View full text Add to dashboard Cite

Background: Immunoglobulin A (IgA) nephropathy is the most common cause of primary glomerulonephritis with slow progression to end-stage renal disease (ESRD) in up to 40% of patients. Methods: A retrospective cohort study of patients with biopsy-proven IgA nephropathy was performed in our center from 1998 to 2009. We tried to determine the clinical and pathological factors which affect patients progressing to ESRD. We also compared the impact of renin-angiotensin system (RAS) blockers therapy alone or in combination with prednisone on baseline proteinuria and glomerular filtration rate (GFR) after 6 months of treatment in patients with proteinuria>1 g/d and GFR>30 mL/min. Results: There were 70 IgA nephropathy patients of whom 46 were men. The average age of patients at biopsy was 39 ± 12.1 years. During the median 23.5 (6-130) months of follow-up, 10 patients progressed to ESRD and no patient died. Five-year renal survival following biopsy was 88%. By multivariate analysis, age more than 50 years (p = 0.003) and baseline serum creatinine level (p = 0.012) were independent predictors of progressing to ESRD and poor prognosis. Although there was no significant difference in proteinuria reduction after 6 months of treatment, kidney function was less preserved in RAS inhibitors therapy alone than in the combination treatment with prednisone. Conclusion: We showed that late diagnosis of patients with IgA nephropathy might be associated with poor outcome. Our results also suggest that addition of prednisone to RAS blockers may lead to better preservation of kidney function.

show abstract

A Novel Simpler Histological Classification for Renal Survival in IgA Nephropathy: A Retrospective Study

Cited by 145 publications

References 33 publications

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

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

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

Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran

Contact Info

Product

Resources

About