Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Nephrol Dial Transplant. 2012 Feb;27(2):715-22. doi: 10.1093/ndt/gfr339. Epub 2011 Jul 12.
There has been a lack of international consensus on the classification and the predictive value of the histopathology findings in IgA nephropathy (IgAN). Recently, the International IgA Nephropathy Network has developed the Oxford classification in which four histological variables with the most prognostic importance are identified (MEST score). Our objective was to validate these findings and to assess their predictive power in our cohort and to compare them to identified clinical predictors.
Ninety-nine children with a follow-up time >5 years were included and investigated with clearances of inulin or iohexol for glomerular filtration rate (GFR), proteinuria and blood pressure at biopsy and during follow-up. Biopsies (90/99) were re-evaluated and scored according to the Oxford classification.
Eighteen patients progressed to a poor outcome [end-stage renal disease (ESRD) or GFR reduction >50%]. In the univariate analysis, we found that mesangial hypercellullarity score >0.5, presence of endocapillary hypercellularity or tubular atrophy/interstitial fibrosis of >25% were each associated with a poor outcome, and also presence of cellular or fibrocellular crescents and of global glomerulosclerosis, but segmental glomerulosclerosis did not reach statistical significance. The clinical predictors of a poor outcome were a low GFR, a high mean arterial blood pressure and a high amount of albuminuria (log Ualb/c) at time of biopsy and low GFR and a high log Ualb/c during follow-up.
We found that three of the four histology lesions identified in the Oxford classification, as well as presence of crescents, were valid in predicting a poor outcome in our cohort of patients.
在 IgA 肾病（IgAN）的分类和组织病理学发现的预测价值方面，一直缺乏国际共识。最近，国际 IgA 肾病网络制定了牛津分类，其中确定了四个具有最重要预后意义的组织学变量（MEST 评分）。我们的目的是验证这些发现，并评估它们在我们的队列中的预测能力，并将其与已确定的临床预测因素进行比较。
纳入了 99 例随访时间>5 年的儿童，并用菊粉或碘海醇清除率评估肾小球滤过率（GFR）、蛋白尿和活检及随访期间的血压。对 90/99 例活检进行重新评估，并根据牛津分类进行评分。
18 例患者进展为不良结局[终末期肾病（ESRD）或 GFR 降低>50%]。在单因素分析中，我们发现系膜细胞增生>0.5、内皮层细胞增多或肾小管萎缩/间质纤维化>25%、细胞性或纤维细胞性新月体形成以及球性肾小球硬化均与不良结局相关，但节段性肾小球硬化未达到统计学意义。不良结局的临床预测因素是活检时 GFR 低、平均动脉血压高和白蛋白尿（log Ualb/c）高，以及随访期间 GFR 低和 log Ualb/c 高。
我们发现，牛津分类中确定的四个组织学病变中的三个，以及新月体形成，在预测我们的患者队列的不良结局方面是有效的。
