Predictive Capabilities of Three Widely Used Pathology Classification Systems and a Simplified Classification (Beijing Classification) in Primary IgA Nephropathy

Duan, Shuwei; Mei, Yan; Liu, Jian; Chen, Pu; Li, Ping; Chen, Yizhi; Lin, Shupeng; Zhang, Xueguang; Liu, Jiaona; Sun, Xuefeng; Cai, Guangyan; Liu, Shuwen; Wu, Jie; Chen, Xiangmei

doi:10.1159/000500459

Cited by 5 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4] The Oxford group recognized that even lower reproducibility could be expected in routine practice without the advantage of the iterative processes of the working group. 1 This was confirmed by two large studies 15,23 with independent observers and lower reliability statistics than the others, 19,21,24,25 which were considered less representative of everyday application of the classification (Table 1). In these two, 15,23 agreement was moderate for T, moderate or poor for M and S, and poor for E and C. The Oxford group gave its view: "We conclude that differences in the scoring of MEST-C criteria between local pathologists and a central reviewer have a significant impact on the prognostic value of the Oxford classification."…”

Section: Discussionmentioning

confidence: 78%

Systematic Review of the Oxford Classification of IgA Nephropathy: Reproducibility and Prognostic Value

Howie

Lalayiannis

2023

Kidney360

View full text Add to dashboard Cite

Background The Oxford classification of IgA nephropathy defined five prognostic features scored subjectively in renal biopsies, mesangial cellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), interstitial fibrosis/tubular atrophy (T), and (fibro)cellular crescents (C). Pathological scoring systems should be reproducible and have prognostic value independently of clinical features. Reproducibility of the classification was not previously investigated in a systematic review, and the most recent systematic reviews of prognostic value were in 2017. Methods This systematic review followed PRISMA 2020 guidelines. MEDLINE, PUBMED, and EMBASE databases were searched using the terms “IgA nephropathy” and “Oxford”. Eligible papers applied the classification and mentioned statistical analysis of interobserver reproducibility and/or included multivariate analysis of outcomes related to individual Oxford scores and clinical features, including treatment with corticosteroids or other immunosuppressive drugs. Results There were 99 suitable papers before 23 September 2022. Of 12 papers that mentioned reproducibility, only six reported statistics for MEST/MESTC scoring. Four of these were small studies and/or had observers at the same institution. These were considered less representative of application of the classification than two large studies with independent observers, in which agreement was moderate for T, either moderate or poor for M and S, and poor for E and C. In 92 papers with 125 multivariate analyses of various outcomes, the commonest Oxford element associated with outcomes was T (73/125, 58%), with no correlation of any element with outcomes in 30 analyses (24%). Treatment with immunosuppression was often related to scores, particularly C and E, without consistent relations between Oxford scores and outcomes in immunosuppressed patients. Conclusions This systematic review showed limitations of the Oxford classification in practice, particularly the moderate or poor reproducibility of scores. T was the Oxford score most often related to clinical outcomes, but even this was not consistently reliable as a prognostic indicator.

show abstract

Section: Discussionmentioning

confidence: 78%

Systematic Review of the Oxford Classification of IgA Nephropathy: Reproducibility and Prognostic Value

Howie

Lalayiannis

2023

Kidney360

View full text Add to dashboard Cite

show abstract

“…In 1982, Lee et al sorted IgAN patients into the grades 1 through 5 of pathological damage (i.e., mesangial cell proliferation, glomerulosclerosis, C formation, and tubulointerstitial alteration) [ 3 ]; the higher the grade of IgAN, the more severe the disease is and the shorter the survival is. Because Lee’s grading for IgAN is simple and easy to operate, it is useful in guiding treatment choices and predicting clinical outcomes [ 4 , 5 , 6 ]. However, this classification has some shortcomings, mainly lacking an objective evaluation of pathological manifestations [ 7 ], which may lead to a biased prediction of prognosis.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of crescent score in clinical prognosis of IgA nephropathy

et al. 2022

View full text Add to dashboard Cite

The scoring of crescents (Cs) was recently added to the Oxford classification for IgA nephropathy (IgAN). Because of the short-term use of the C score in clinical practice, its validity and applicability need to be verified. We, retrospectively, analyzed the clinicopathological data of 144 primary IgAN patients diagnosed at our hospital from March 2017 to March 2019 and with complete ≥6-month follow-up data. We found that the C score was positively correlated with the Lee’s classification in the assessment of renal pathological changes and significantly correlated with increased proteinuria and decreased estimated glomerular filtration rate. Univariate Cox regression analysis showed an association of C formation with IgAN prognosis, and multivariate Cox regression indicated Cs as an independent prognosis factor. The optimal proportion of Cs for prognosis prediction by the receiver operating characteristic curve was 11%. Kaplan–Meier survival curve revealed a significantly decreased renal survival rate in patients with C proportions ≥11%. Further multivariate Cox regression analysis confirmed that the C proportion ≥11% is an independent risk factor for poor prognosis of IgAN patients. Our findings demonstrate that Cs are independently related to the prognosis of patients with IgAN, and the proportion of Cs ≥11% is an independent risk factor for poor outcomes.

show abstract

“…A renal biopsy was performed when laboratory and clinical data predicted the possibility of significant nephritis and the need for additional treatment, especially immunosuppressive therapy. The histopathology in all three patients showed IgA glomerulonephritis grade III according to Haas, grade III according to Lee, and M1E1S0T0 according to the Oxford classification (11). One of the patients, an active athlete, refused renal biopsy and immunosuppressive treatment.…”

Section: Resultsmentioning

confidence: 93%

Henoch–Schönlein purpura – obravnava in zdravljenje pediatričnih bolnikov severovzhodnega dela Slovenije

Močnik

Varda

2022

AMB

View full text Add to dashboard Cite

Purpose: Henoch–Schönlein purpura (HSP) is the most common type of vasculitis in childhood and has a good prognosis. The aim of our study was to compare the clinical characteristics of children with HSP diagnosed in north–east Slovenia with existing data from other countries. Methods: We retrospectively reviewed the data of patients with HSP in our department between 2005 and 2018, and assessed their clinical characteristics, laboratory results, and treatment at presentation. We also analysed how many patients relapsed, the causes of this, and the treatment administered. These parameters were compared with previously published research. Results: During the study period, 123 patients with HSP were treated in our department. The median patient age was 6.0 years (interquartile range: 4–9 years) with a uniform distribution between the sexes. Along with purpura, 52.8% presented with arthropathy, 19.5% with abdominal pain, and up to 10% with renal involvement. Patients received supportive therapy the most frequently. Non–steroidal anti–inflammatory drugs were prescribed to 61.8% of patients and corticosteroids to 13%. Relapse occurred in 15.4% of patients, most presenting with skin purpura and kidney manifestations. Conclusion: The basic demographic data of our patients were comparable to those of other similar published studies. The order of frequency of individual organ system involvement was also similar, but the percentages were lower. Purpura–accompanying manifestations were reported less often in our study than in previous studies. Compared to other studies, supportive therapy alone was prescribed more frequently to our patients, and corticosteroids were rarely administered. Compared to other studies, a smaller proportion of patients with relapse was recorded.

show abstract

Predictive Capabilities of Three Widely Used Pathology Classification Systems and a Simplified Classification (Beijing Classification) in Primary IgA Nephropathy

Cited by 5 publications

References 20 publications

Systematic Review of the Oxford Classification of IgA Nephropathy: Reproducibility and Prognostic Value

Systematic Review of the Oxford Classification of IgA Nephropathy: Reproducibility and Prognostic Value

Retrospective analysis of crescent score in clinical prognosis of IgA nephropathy

Henoch–Schönlein purpura – obravnava in zdravljenje pediatričnih bolnikov severovzhodnega dela Slovenije

Contact Info

Product

Resources

About