Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
BMC Nephrol. 2012 Nov 27;13:158. doi: 10.1186/1471-2369-13-158.
The Oxford classification of IgA nephropathy (IgAN) provides a useful tool for prediction of renal prognosis. However, the application of this classification in children with IgAN needs validation in different patient populations.
A total of 218 children with IgAN from 7 renal centers in China were enrolled. The inclusion criteria was similar to the original Oxford study.
There were 98 patients (45%) with mesangial proliferation (M1), 51 patients (23%) with endocapillary proliferation (E1), 136 patients (62%) with segmental sclerosis/adhesion lesion (S1), 13 patients (6%) with moderate tubulointerstitial fibrosis (T1 26-50% of cortex scarred), and only 2 patients (1%) with severe tubulointerstitial fibrosis (T2, >50% of cortex scarred). During a median follow-up duration of 56 months, 24 children (12.4%) developed ESRD or 50% decline in renal function. In univariate COX analysis, we found that tubular atrophy/interstitial fibrosis (HR 4.3, 95%CI 1.8-10.5, P < 0.001) and segmental glomerulosclerosis (HR 9.2 1.2-68.6, P = 0.03) were significant predictors of renal outcome. However, mesangial hypercellularity, endocapillary proliferation, crescents, and necrosis were not associated with renal prognosis. In the multivariate COX regression model, none of these pathologic lesions were shown to be independent risk factors of unfavorable renal outcome except for tubular atrophy/interstitial fibrosis (HR 2.9, 95%CI 1.0-7.9 P = 0.04).
We confirmed tubular atrophy/interstitial fibrosis was the only feature independently associated with renal outcomes in Chinese children with IgAN.
IgA 肾病的牛津分类（IgAN）为预测肾脏预后提供了有用的工具。然而，该分类在 IgAN 患儿中的应用需要在不同的患者人群中进行验证。
共纳入中国 7 家肾脏中心的 218 例 IgAN 患儿。纳入标准与原始牛津研究相似。
98 例（45%）患者为系膜细胞增殖（M1），51 例（23%）患者为毛细血管内增殖（E1），136 例（62%）患者为节段性肾小球硬化/粘连病变（S1），13 例（6%）患者为中重度肾小管间质纤维化（T1，26-50%皮质瘢痕化），仅有 2 例（1%）患者为重度肾小管间质纤维化（T2，>50%皮质瘢痕化）。在中位随访 56 个月期间，24 例患儿（12.4%）进展为 ESRD 或肾功能下降 50%。单因素 COX 分析发现，肾小管萎缩/间质纤维化（HR 4.3，95%CI 1.8-10.5，P<0.001）和节段性肾小球硬化（HR 9.2，1.2-68.6，P=0.03）是肾脏结局的显著预测因子。然而，系膜细胞增多、毛细血管内增殖、新月体和坏死与肾脏预后无关。在多因素 COX 回归模型中，除肾小管萎缩/间质纤维化（HR 2.9，95%CI 1.0-7.9，P=0.04）外，这些病变均未被证明是不良肾脏结局的独立危险因素。
我们证实，肾小管萎缩/间质纤维化是中国 IgAN 患儿肾脏结局的唯一独立相关特征。
