A multicenter application and evaluation of the oxford classification of IgA nephropathy in adult chinese patients

Cai-Hong Zeng, Weibo Le, Zhaohui Ni, Minfang Zhang, Lining Miao, Ping Luo, Rong Wang, Zhimei Lv, Jianghua Chen, Jiong Tian, Nan Chen, Xiaoxia Pan, Ping Fu, Zhangxue Hu, Lining Wang, Qiuling Fan, Hongguang Zheng, Dewei Zhang, Yaping Wang, Yanhong Huo, Hongli Lin, Shuni Chen, Shiren Sun, Yanxia Wang, Zhangsuo Liu, Dong Liu, Lu Ma, Tao Pan, Aiping Zhang, Xiaoyu Jiang, Changying Xing, Bing Sun, Qiaoling Zhou, Wenbing Tang, Fuyou Liu, Yinghong Liu, Shaoshan Liang, Feng Xu, Qian Huang, Hongbing Shen, Jianming Wang, Yu Shyr, Sharon Phillips, Stéphan Troyanov, Stéphan Trojanov, Agnes Fogo, Zhi-Hong Liu
American Journal of Kidney Diseases 2012, 60 (5): 812-20

BACKGROUND: The Oxford classification of immunoglobulin A (IgA) nephropathy (IgAN) provides a histopathologic grading system that is associated with kidney disease outcomes independent of clinical features. We evaluated the Oxford IgAN classification in a large cohort of patients from China.

STUDY DESIGN: Retrospective study.

SETTING & PARTICIPANTS: 1,026 adults with IgAN from 18 referral centers in China. Inclusion criteria and statistical analysis were similar to the Oxford study.

PREDICTORS: Histologic findings of mesangial hypercellularity score, endocapillary proliferation, segmental sclerosis or adhesion, crescents, necrosis, and tubular atrophy/interstitial fibrosis. Clinical features, blood pressure, estimated glomerular filtration rate (eGFR), proteinuria, and treatment modalities.

OUTCOMES: Time to a 50% reduction in eGFR or end-stage renal disease (the combined event); the rate of eGFR decline (slope of eGFR); proteinuria during follow-up.

RESULTS: Compared with the Oxford cohort, the Chinese cohort had a lower proportion of patients with mesangial hypercellularity (43%) and endocapillary proliferation (11%), higher proportion with segmental sclerosis or adhesion (83%) and necrosis (15%), and similar proportion with crescents (48%) and tubular atrophy/interstitial fibrosis (moderate, 24%; severe, 3.3%). During a median follow-up of 53 (25th-75th percentile, 36-67) months, 159 (15.5%) patients reached the combined event. Our study showed that patients with a mesangial hypercellularity score higher than 0.5 were associated with a 2.0-fold (95% CI, 1.5-2.8; P<0.001) higher risk of the combined event than patients with a score of 0.5 or lower. Patients with tubular atrophy/interstitial fibrosis of 25%-50% and >50% versus <25% were associated with a 3.7-fold (95% CI, 2.6-5.1; P<0.001) and 15.1-fold (95% CI, 9.5-24.2; P<0.001) higher risk of the combined event, respectively. Endocapillary proliferation, glomerular crescents, and necrosis were not significant.

LIMITATIONS: Retrospective study; the therapeutic interventions were miscellaneous.

CONCLUSIONS: We confirmed the associations of mesangial hypercellularity and tubular atrophy/interstitial fibrosis with kidney disease outcomes.

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