Abstract
The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN). Based on the upper reference limit (95th percentile) for the number of globally sclerotic glomeruli (GSG) expected on biopsy according to age, we evaluated whether the prognosis of IgAN was affected by the age-calibrated numbers of GSG independent of the Oxford classification. Patients diagnosed with IgAN on renal biopsy in a single center from January 2011 to December 2018 were analyzed retrospectively. Patients with more GSG number than the upper reference limit expected on biopsy according to age were categorized in a group of GSG abnormal for age. We analyzed in two ways, calculating the median rate of decline in estimated glomerular filtration rate (eGFR) and time-to-event defined as a decline of eGFR level to 40% lower than the baseline. There were 111 patients in the group of GSG abnormal for age. In this group, the rate of eGFR decline was faster by 1.85 (3.68–0.03) ml/min/1.73 m2 per year in the fully-adjusted robust regression model. The adjusted hazard ratio for eGFR decline for renal outcome was 29.10 (2.18–388.49). The cumulative incidence of CKD progression was significantly higher, especially for those with T score of 0 in the Oxford classification. We suggest that GSG abnormal for age is an independent risk factor in predicting the renal outcome of IgAN.
Highlights
The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN)
Chronic histological abnormalities described as nephrosclerosis, including global glomerulosclerosis, interstitial fibrosis and tubular atrophy (IF/TA, i.e., T score by the Oxford classification), and arteriosclerosis, are seen in patients with chronic kidney disease (CKD) and healthy aging adult[12]
Among the Oxford classification, M, S, T, and C scores were higher in the group with globally sclerotic glomeruli (GSG) abnormal for age
Summary
The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN). Based on the upper reference limit (95th percentile) for the number of globally sclerotic glomeruli (GSG) expected on biopsy according to age, we evaluated whether the prognosis of IgAN was affected by the agecalibrated numbers of GSG independent of the Oxford classification. We suggest that GSG abnormal for age is an independent risk factor in predicting the renal outcome of IgAN. Chronic histological abnormalities described as nephrosclerosis, including global glomerulosclerosis, interstitial fibrosis and tubular atrophy (IF/TA, i.e., T score by the Oxford classification), and arteriosclerosis, are seen in patients with CKD and healthy aging adult[12]. The objective of this study was to investigate whether the prognosis of IgAN might be affected by age-calibrated numbers of GSG independent of T score of the Oxford classification
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