Abstract
The Oxford classification of IgA nephropathy (IgAN) can evaluate each MEST-C score individually. We analysed a new grading system that utilised the total MEST-C score in predicting renal prognosis. Altogether, 871 IgAN patients were classified into three groups using the new Oxford classification system (O-grade) that utilised the total MEST-C score (O-grade I: 0–1, II: 2–4, and III: 5–7 points), and the 10-year renal prognosis was analysed. The clinical findings became significantly severer with increasing O-grades, and the renal survival rate by the Kaplan–Meier method was 94.1%, 86.9%, and 74.1% for O-grades I, II, and III, respectively. The hazard ratios (HRs) for O-grades II and III with reference to O-grade I were 2.8 (95% confidence interval [CI] 1.3–6.0) and 6.3 (95% CI 2.7–14.5), respectively. In the multivariate analysis, mean arterial pressure and eGFR, proteinuria at the time of biopsy, treatment of corticosteroids/immunosuppressors, and O-grade (HR 1.63; 95% CI 1.11–2.38) were the independent factors predicting renal prognosis. Among the nine groups classified using the O-grade and Japanese clinical-grade, the renal prognosis had an HR of 15.2 (95% CI 3.5–67) in the severest group. The O-grade classified by the total score of the Oxford classification was associated with renal prognosis.
Highlights
IgA nephropathy (IgAN) has been recognised as the most common chronic glomerulonephritis with a mild to poor prognosis depending on the clinical and pathological backgrounds[1,2]
This histological classification combined with the clinical classification (C-grade) according to the estimated glomerular filtration rate and proteinuria was referred to as the Japanese histological classification to predict the prognosis of IgAN7,10
We aimed to introduce our new grading system that utilised the total MEST-C score in the Oxford classification and to analyse whether the Oxford classification grade (O-grade) was related to renal prognosis
Summary
IgA nephropathy (IgAN) has been recognised as the most common chronic glomerulonephritis with a mild to poor prognosis depending on the clinical and pathological backgrounds[1,2]. In the Oxford classification, the pathological findings of mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) were selected through univariate and multiple regression analyses, and the Cox proportional hazard regression model and cellular/fibrocellular crescent formation (C) were selected in 20165,8,9 In this classification, each pathological finding can be assessed individually as a split system, and there have been many validation studies on this classification that have assessed its efficacy in evaluating the prognosis of I gAN11–16. The Oxford classification only evaluated the pathological findings, and it might be more useful if it could predict the renal prognosis as well, by combining this grading system with the Japanese histological classification that utilised clinical findings.
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