Severity of nephrotic IgA nephropathy according to the Oxford classification

Moriyama, Takahito; Nakayama, Kayu; Iwasaki, Chihiro; Ochi, Ayami; Tsuruta, Yuki; Itabashi, Mitsuyo; Tsukada, Misao; Takei, Takashi; Uchida, Keiko; Nitta, Kosaku

doi:10.1007/s11255-011-0109-5

Cited by 37 publications

(22 citation statements)

References 11 publications

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“…1 Kruskal-Wallis test: P < 0.0008 biopsies the receptor for the chemokine RANTES (CCRR5) was expressed by interstitial but not by glomerular macrophages [24]. A persistent high level of proteinuria is associated with severe histological lesions, including high scores of Oxford classification parameters [4,23,25,26]. In our study proteinuria levels did not correlate with histological findings.…”

Section: Discussionmentioning

confidence: 49%

Prognostic value of morphologic and morphometric analyses in IgA nephropathy biopsies

et al. 2016

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Background: IgA nephropathy (IgAN) exhibits a variable course ranging from a benign condition to progressive renal failure with a high proportion of patients undergoing end-stage renal disease in the long term. It is unclear how to predict the risk of this progression. Mesangial C4d deposition has been found to be associated with a poor prognosis. Our aim was to search histological lesions with possible prognostic value in IgAN biopsies performed at the time of the diagnosis. Methods: Clinical and laboratory records of 44 patients undergoing renal biopsy were reviewed. IgAN was diagnosed in 32 patients and minimal change disease (MCD) in 12. C4d deposition, glomerular endothelial cell area, glomerular and interstitial macrophages were evaluated in all biopsies. Clinical and laboratory data were available in all IgAN patients at the time of diagnosis and in 21 patients at the end of follow-up (mean follow-up 48.09 ± 19.69 months). Results: All IgAN and MCD biopsies were C4d negative. The number of glomerular macrophages and the area of glomerular endothelial cells in IgAN were greater than in MCD (P < 0.001 and P < 0.0001, respectively), indicating glomerular inflammation associated with endothelial cell enlargement. Glomerular macrophages positively correlated with diffuse IgA and fibrinogen immunoreactivity (P < 0.02 and P < 0.002, respectively). Interstitial macrophages positively correlated with segmental glomerulosclerosis (P < 0.01) and tubular atrophy (P < 0.001), according to the Oxford classification. They correlated with hypertension (P < 0.03) and renal functional impairment both at the time of biopsy and at the end of follow-up. The receiver operating characteristic analysis curve and a cut-off value of ≥19.5 macrophages per high power field showed 75.0% sensitivity and 88.9% specificity in predicting worse clinical outcome. A Poisson generalized regression fit model showed that hypertension and tubular atrophy were the most significant factors in predicting a high number of interstitial macrophages. Conclusions: The number of interstitial macrophages correlated with hypertension, histological damage, functional impairment at the time of biopsy and worse outcome. A high number of interstitial macrophages in C4d negative biopsies may allow the identification of patients at increased risk of progression to renal failure.

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Section: Discussionmentioning

confidence: 49%

Prognostic value of morphologic and morphometric analyses in IgA nephropathy biopsies

et al. 2016

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“…A majority confirm the prognostic value of the Tscore in multivariate analysis, 28,[63][64][65]67,68,[70][71][72][73][74]76,77 and several also confirm that the Mscore and/or Sscore are indepen dent predictors of outcome. 28,[62][63][64][65]67,69,72,73 Most studies use renal survival as the clinical end point and it is, therefore, not surprising that tubular atrophy/interstitial fibrosis (Tscore) is the strongest histological predictor of outcome, as a high Tscore reflects advanced disease at the time of diagnosis.…”

Section: Validating the Oxford Classificationmentioning

confidence: 77%

Pathology of IgA nephropathy

2014

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IgA nephropathy is defined by the presence of IgA-dominant or co-dominant immune deposits within glomeruli. Biopsy specimens meeting these diagnostic criteria have a range of histological changes that are reflected in the variable clinical course of IgA nephropathy. The impact of histology on outcomes in IgA nephropathy has been clarified in a number of large retrospective clinicopathological studies. These studies have consistently demonstrated that the stage of disease at presentation, as indicated by the extent of interstitial fibrosis and tubular atrophy in the biopsy, is the strongest histological predictor of renal survival. The effect of active proliferative lesions on the disease course is less clear cut, owing in part to considerable treatment bias in most published retrospective studies. There is evidence that endocapillary hypercellularity and cellular crescents are responsive to immunosuppressive therapy, but this observation requires confirmation in prospective randomized controlled trials. Future challenges include improving the reproducibility of histological scoring, particularly for the presence and extent of endocapillary lesions, and to improve prognostic modelling by combining histological data with clinical variables and biomarker data.

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“…Oxford classification of IgA nephropathy is identified by four histological features, mesangial cellularity, endocapillary proliferation, segmental sclerosis and tubular atrophy/interstitial fibrosis, which are the independent predictors of clinical outcome (25)(26)(27)(30)(31)(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%