Department of Nephrology, Rush University Medical Center, Chicago, IL 60607, USA.
Am J Nephrol. 2011;34(5):435-44. doi: 10.1159/000332223. Epub 2011 Sep 28.
BACKGROUND/AIMS: The Oxford classification of IgA nephropathy (IgAN) assesses the presence of mesangial hypercellularity ≥50% (M1 vs. 0), endocapillary proliferation (E1 vs. 0), segmental glomerulosclerosis (S1 vs. 0), tubular atrophy/interstitial fibrosis >25 or 50% (T1 or 2 vs. 0), and has been reported as having prognostic value. We studied the clinical significance of the classification in our adult patients with IgAN.
Retrospective study of 54 patients with biopsy-proven IgAN seen from 1983 to 2009. The correlation between the Oxford classification and baseline renal function was assessed. The primary endpoint was a 50% reduction in eGFR or end-stage renal disease. Predictors for progression to the endpoint were determined by multivariate analyses.
Patients were 41 ± 15 years of age with a serum creatinine of 1.5 ± 0.8 mg/dl, eGFR of 61 ± 24 ml/min/1.73 m(2), and proteinuria of 2.0 ± 1.6 g/day. Oxford classifications were as follows: M1 = 72%, E1 = 20%, S1 = 81%, and T1 = 13%/T2 = 22%. During the follow-up of 5.8 ± 4.8 years, 19% of patients reached the primary endpoint. While the Oxford classification was associated with progressive renal disease, only the T score (T0, T1, T2) was predictive of outcome with 6, 29, and 50% of patients (p = 0.002) reaching the primary endpoint. The 10-year renal survival for T0, T1, and T2 was 100, 50, and 17%, respectively (p < 0.001). By multivariate analysis, the hazard ratio for reaching the primary endpoint was 32 for patients with T ≥1 versus T0 (p = 0.01).
In our experience, the Oxford classification predicts progressive renal disease, but the degree of tubulointerstitial fibrosis was the only feature independently predictive of outcome.
背景/目的：牛津 IgA 肾病分类（IgAN）评估系膜细胞增生≥50%（M1 与 0 相比）、内皮下细胞增生（E1 与 0 相比）、节段性肾小球硬化（S1 与 0 相比）、肾小管萎缩/间质纤维化＞25%或 50%（T1 或 2 与 0 相比），并已被报道具有预后价值。我们研究了该分类在我们的成人 IgAN 患者中的临床意义。
回顾性研究了 1983 年至 2009 年间经活检证实的 54 例 IgAN 患者。评估了牛津分类与基线肾功能之间的相关性。主要终点是 eGFR 降低 50%或终末期肾病。通过多变量分析确定进展至终点的预测因素。
患者年龄为 41±15 岁，血清肌酐为 1.5±0.8mg/dl，eGFR 为 61±24ml/min/1.73m2，蛋白尿为 2.0±1.6g/天。牛津分类如下：M1 为 72%，E1 为 20%，S1 为 81%，T1 为 13%/T2 为 22%。在 5.8±4.8 年的随访期间，19%的患者达到了主要终点。尽管牛津分类与进行性肾病相关，但只有 T 评分（T0、T1、T2）是预测结局的指标，6%、29%和 50%的患者（p=0.002）达到了主要终点。T0、T1 和 T2 的 10 年肾脏存活率分别为 100%、50%和 17%（p<0.001）。多变量分析显示，T≥1 与 T0 相比，达到主要终点的风险比为 32（p=0.01）。
根据我们的经验，牛津分类预测进行性肾病，但肾小管间质纤维化的程度是唯一独立预测结局的特征。
Zotero 插件