Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis

Xu, Ke; Zhang, Lili; Ding, Jie; Wang, Suxia; Su, Baige; Hu, Xin; Wang, Fang; Zhong, Xing; Liu, Yanming

doi:10.1007/s40620-017-0457-z

Cited by 53 publications

(52 citation statements)

References 31 publications

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“…T1 and 2 lesions were, however, negatively associated with the risk of proteinuria remission while other lesions showed no significant association. Interestingly, the number of biopsies with especially E1 and T1 and 2 in the study by Xu et al [23] differs from ours. This may reflect inter-observer variation between pathologists or differences in patient material and biopsy timing.…”

Section: Discussioncontrasting

confidence: 94%

Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings

et al. 2019

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Background In Henoch-Schönlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable. Methods We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up. Results Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p < 0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053). Conclusions Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.

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Section: Discussioncontrasting

confidence: 94%

Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings

et al. 2019

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“…The study showed, mesangial proliferation (M1) was significantly associated with tubular atrophy/interstitial fibrosis (T score) and proteinuria. Moreover, crescents in more than 25% of glomeruli (C2) were associated with reduced eGFR (estimated glomerular filtration rate) at the time of biopsy (37). This study showed that patients with endocapillary proliferation (E1), mesangial proliferation (M1), segmental glomerulosclerosis (S1) and extracapillary proliferation (C1 and C2) were more likely to respond to high-dose methylprednisolone.…”

Section: Discussionmentioning

confidence: 68%

Predicting renal outcomes in immunoglobulin A vasculitis nephritis; from ISKDC classification to Oxford MEST-C classification

Sepahi

Mubarak

2019

J Renal Inj Prev

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Immunoglobulin A vasculitis nephritis (IgAVN) or Henoch-Schönlein purpura nephritis (HSPN) is the most common type of secondary IgA nephropathy (IgAN), particularly in children. Overall, its prognosis is good, but in a significant number of cases, it does lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Various classifications exist to predict the long-term outcome of kidney disease in these diseases, but none is universally accepted. We searched PubMed, Web of Science Embase, EBSCO, Scopus and directory of open access journals (DOAJ) with keywords of Henoch-Schönlein purpura nephritis, immunoglobulin A vasculitis nephritis, immunoglobulin A nephropathy, IgA vasculitis, extracapillary proliferation, IgA nephropathy, leukocytoclastic vasculitis, endstage renal disease, Oxford classification, crescent and childhood IgA vasculitis. IgAVN in children presents most often with crescents and endocapillary proliferation, with relapsing and remitting course clinically. Due to morphological resemblance of IgAVN and IgAN, the Oxford MEST-C scores could be applied for determining the long-term outcomes in the former disease. A critical concern in applying Oxford classification for IgAVN is that limited number of children with IgAVN exists in any one center and also a relatively short period of follow-up. Hence, further work in this regard is necessary. Preliminary evidence suggests that Oxford MEST-C classification is valid in predicting long-term kidney outcomes in children with IgAVN and the classification can also be used in adults. However, further, large scale, multicenter, international collaborative studies are needed to address the unmet issues.

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“…Another study found that E1 lesions were the only significant variable related to renal outcomes [16]. A study of 104 children showed that S1 lesions were predictors of renal outcome, and T1/T2 were risk factors for nonremission from proteinuria [18]. A recent study involving 75 children with HSPN found that T1/T2 was an independent predictor of renal outcome, whereas the effect of S1 was dependent on the other variables [17].…”

Section: Discussionmentioning

confidence: 98%

“…Pooled analysis of the predictability of MEST and MEST-C scores for HSPN patients was performed using four previous studies [16][17][18][19], although the relationship for C score in adults could not be determined because the C score was defined differently in one study [19]. Two hundred ninety-two children and 235 adults were included in the meta-analysis, and their information is summarized in Table 4.…”

Section: Pooled Analysis With Previous Studiesmentioning

confidence: 99%

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MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Yun

Joo

et al. 2020

BMC Nephrol

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Background: Henoch-Schönlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved. Methods: Two hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged < 18 years (9.2 ± 3.6 years) and 100 adults aged ≥18 years (38.6 ± 18.3 years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail.Results: Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median followup periods of 12 years and 13 years, respectively (maximum 19 years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores. Conclusions: The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.

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Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis

Cited by 53 publications

References 31 publications

Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings

Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings

Predicting renal outcomes in immunoglobulin A vasculitis nephritis; from ISKDC classification to Oxford MEST-C classification

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

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