The Oxford Classification of IgA Nephropathy: A Retrospective Analysis

Yau, Timothy; Korbet, Stephen M.; Schwartz, Melvin M.; Cimbaluk, David

doi:10.1159/000332223

Cited by 47 publications

(42 citation statements)

References 50 publications

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“…These inconsistencies may be due to insufficient statistical power resulting from the small sample sizes of the studies. Like most previous studies, the present study failed to reveal a significant association of E with renal prognosis (15,18,36). Therefore, the variables included in our prediction rule would seem to be reasonable for application to research or clinical studies.…”

Section: Variables Scoressupporting

confidence: 51%

“…In this study, M, S, and T were independently associated with renal outcome. T has been established as a significant prognostic factor associated with renal outcome in other studies, whereas the effects of M and S on renal prognosis have been inconsistent among studies (11,15,16,36). Some reports showed that M or S were not both selected as risk factors for future ESRD in multivariate analysis (15,16,36).…”

Section: Variables Scoresmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Variables Scoressupporting

confidence: 51%

Section: Variables Scoresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

“…Other similar studies have been presented at the American Society of Nephrology's Renal Week 2010. A retrospective study from Chicago in 72 patients (16) and one from Korea in 181 patients (17) came to the conclusion that only tubulointerstitial fibrosis was predictive of outcome. Another study from Japan (18) emphasized on the importance of crescents, which were probably excluded from the Oxford study.…”

Section: Discussionmentioning

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

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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.

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“…Previously Lee and Haas, have published a classifications method for IgAN (15)(16)(17)(18)(19)(20). The recent Oxford classification of IgAN assesses the presence of hypercellularity, proliferation in mesangial and endocapillary regions, segmental glomerulosclerosis and tubular atrophy/interstitial (MEST).Also it has been reported as having prognostic value (14,(21)(22)(23)(24). This classification method looked for reproducible pathological features that were correlated to renal survival independent of clinical features, rather than grouping patients into categories (24).…”

Section: Introductionmentioning

confidence: 99%