Clinical usefulness of the Oxford classification in determining immunosuppressive treatment in IgA nephropathy. (3rd April 2017)

• Record Type: Journal Article
• Authors: Yoon, Chang-Yun; Chang, Tae Ik; Kang, Ea Wha; Lim, Beom Jin; Kie, Jeong Hae; Kee, Youn Kyung; Kim, Hyoungnae; Park, Seohyun; Yun, Hae-Ryong; Jung, Su-Young; Jhee, Jong Hyun; Kwon, Young Eun; Oh, Hyung Jung; Park, Jung Tak; Yoo, Tae-Hyun; Kang, Shin-Wook; Jeong, Hyeon Joo; Han, Seung Hyeok
• Is Part Of: Annals of medicine. Volume 49:Number 3(2017)
• Page Start: 217
• Page End: 229
• Publication Date: 2017-04-03
• Subjects: IgA nephropathy -- Oxford classification -- proteinuria -- glucocorticoid treatment; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2016.1252058
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Background: The Oxford classification has been widely used in IgA nephropathy. However, its clinical usefulness of determining immunosuppression is unknown. Aim: Whether the Oxford classification could predict the development of proteinuria ≥1 g/g Cr and worsening kidney function, as well as the clinical efficacy of corticosteroid treatment according to each histologic variable of the Oxford-MEST. Methods: We included 377 patients with early-stage IgA nephropathy. The study endpoints were the development of a heavy proteinuria and a decline renal function. Results: The results showed that among the Oxford-MEST lesions, only M1 predicted the risk of the development of proteinuria ≥1.0 g/g Cr compared to other lesions in a time-varying Cox model adjusted for multiple confounding factors. In addition, the risk of reaching a 30% decline in eGFR was significantly higher in patients with M1 than in those with M0. Furthermore, patients with M1 had a greater decline of eGFR than patients with M0. However, steroid treatment in M1 lesion was not associated with improving clinical outcomes in the unmatched and propensity score matched cohort. Conclusions: This finding may provide a rationale for using the Oxford classification as a guidance to initiate immunosuppression in the early stages of IgA nephropathy. KEY MESSAGES: M1 has independently predictive role among the Oxford lesions in IgA nephropathy. Oxford classification should be defined during pathologic approach. Decision of starting immunosuppression according to the Oxford lesions.