Abstract
The Oxford classification for IgA nephropathy (IgAN) was updated in 2017. We have validated the revised Oxford classification considering treatment with corticosteroids/immunosuppressors. In this retrospective analysis, 871 IgAN patients were enrolled. Patients were divided into two groups, those treated with or without corticosteroids/immunosuppressors. The 20-year renal prognosis up to end-stage renal disease was assessed using the Oxford classification. In all patients, the renal survival rate was 87.5% at 10 years and 72.6% at 20 years. The T score alone was significantly related to renal prognosis in the Kaplan–Meier analysis and multivariate Cox regression analysis. In the non-treatment group (n = 445), E, S, T, and C scores were significantly related to renal survival rates, however, in the treatment group (n = 426), T score alone was significantly related to renal prognosis on Kaplan–Meier analysis, indicating that corticosteroids/immunosuppressors improved renal prognosis in E1, S1, and C1. In patients with E1, S1, or C1, the treatment group showed significantly better renal prognosis than the non-treatment group in univariate and multivariate analysis. The Oxford classification and T score were used to determine renal prognosis in IgAN patients. Corticosteroids/immunosuppressors improved renal prognosis, especially E1, S1, and C1 scores.
Highlights
In 2009, the Oxford classification was reported by the International IgA nephropathy (IgAN) Network and International Renal Pathology Society[10,11]
We included IgAN patients with eGFR < 30 mL/min/1.73 m2 and progression to ESRD within 1 year who were excluded from the original Oxford classification because it seemed important to include rapidly progressive glomerulonephritis (RPGN) and deteriorated cases at the time of renal biopsy to analyse the risk of cellular and fibrocellular crescents, which were newly included in the Oxford classification as C scores
The longer period of observation to ESRD was deemed to be more appropriate for analysis than the change in eGFR that was used for the validation of the Oxford classification for IgAN (VALIGA) in the European multicentre cohort trial[28,29]
Summary
In 2009, the Oxford classification was reported by the International IgAN Network and International Renal Pathology Society[10,11]. One meta-analysis of 16 validation studies with 2,893 patients confirmed that the M, S, T, and C scores were strongly related to renal p rognosis[26]. Considering those reports and the previous exclusion criterion of eGFR < 30 mL/min/1.73 m2, which meant excluding rapid progressive cases, the MEST. It is important to note, that validation studies of the MEST score have generally excluded patients with rapidly progressing IgAN, defined by an eGFR < 30 mL/min/1.73 m 2. Our aim in this study was to validate the revised Oxford classification (MEST-C score) among patients with IgAN, confirmed by renal biopsy
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