The Association of the Oxford Classification Score with Longitudinal Estimated Glomerular Filtration Rate Decline in Patients with Immunoglobulin A Nephropathy: A Mixed-Method Study
Open Access
- 1 June 2021
- journal article
- research article
- Published by Taylor & Francis Ltd in International Journal of General Medicine
- Vol. ume 14, 2655-2663
- https://doi.org/10.2147/ijgm.s313333
Abstract
Introduction: The Oxford Classification score, which predicts renal outcomes for immunoglobulin A nephropathy (IgAN), is widely used in clinical practice. Nevertheless, the relationship between these markers and longitudinal changes in renal function are poorly understood. Methods: This was a population-based retrospective cohort study of 280 adults with biopsy-proven primary IgAN from 2011 to 2018. We used generalized additive mixed models to control for traditional kidney disease risk factors to analyze the associations between Oxford Classification MEST-C scores (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T; crescents, C) and longitudinal changes in the estimated glomerular filtration rate (eGFR) after renal biopsy. Results: The median eGFR was 78.2 mL/min/1.73 m2 at baseline, and then it decreased on average by 1.3 mL/min/1.73 m2 per year in the entire cohort. In adjusted models, compared with patients without relative lesions, the presence of T > 50% (T2) (− 5.7; 95% confidence interval [CI], − 9.5 to − 2.0 mL/min/1.73m2 per year) was associated with the fastest eGFR decline. S present (S1) (− 2.9; 95% CI, − 4.6 to − 1.1 mL/min/1.73m2 per year) and C > 25% glomeruli (C2) (− 3.4; 95% CI, − 6.4 to − 0.5 mL/min/1.73m2 per year) also demonstrated steeper eGFR declines. However, we found no association between M > 0.5 (M1), E present (E1), T 26%– 50% (T1), and C present ≥ 1 glomerulus (C1), and progressive eGFR decline (p > 0.05). Conclusion: The Oxford Classification scores, S1, T2, and C2, were independently associated with the longitudinal decreases in renal function in patients with IgAN. These findings suggested therapies targeted at improving early damage to these lesions might be essential to delay renal progression.Keywords
This publication has 37 references indexed in Scilit:
- Validation of the Oxford classification of IgA nephropathy for pediatric patients from ChinaBMC Nephrology, 2012
- A Clinicopathologic Study of Thrombotic Microangiopathy in IgA NephropathyJournal of the American Society of Nephrology, 2012
- Validation of the Oxford Classification of IgA Nephropathy: A Single-Center Study in Korean AdultsThe Korean Journal of Internal Medicine, 2012
- Validity of the Oxford classification of IgA nephropathy in childrenPediatric Nephrology, 2011
- Validation Study of Oxford Classification of IgA NephropathyClinical Journal of the American Society of Nephrology, 2011
- Pathologic Predictors of Renal Outcome and Therapeutic Efficacy in IgA NephropathyClinical Journal of the American Society of Nephrology, 2011
- Validation of the Oxford classification of IgA nephropathyKidney International, 2011
- The Oxford classification as a predictor of prognosis in patients with IgA nephropathyNephrology Dialysis Transplantation, 2011
- The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibilityKidney International, 2009
- Natural history of idiopathic IgA nephropathy: Role of clinical and histological prognostic factorsAmerican Journal of Kidney Diseases, 2000