Palamuthusingam Dharmenaan, Castledine Clare, Lawman Sarah
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
Sussex Kidney Unit, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
Saudi J Kidney Dis Transpl. 2018 Mar-Apr;29(2):341-350. doi: 10.4103/1319-2442.229292.
Numerous studies have addressed the predictive value of pathology findings from the Oxford Classification. Whether this influences treatment choice has not been determined. We evaluated patients with IgA nephropathy who were immunosuppressed and correlated our findings with both clinical and histological features as per the Oxford Classification. This was a retrospective observational study of 45 patients who had biopsy-proven IgA nephropathy with a mean follow-up of 2.6 years. Primary outcomes were time to end-stage renal disease (ESRD) or a 50% rise in serum creatinine. Immunosuppression was not associated with lower hazards for both ESRD and 50% rise in serum creatinine. From the Oxford Classification, only T0 was associated with significantly lower hazards for ESRD [hazard ratio (HR), 0.067; confidence interval (CI) 0.01-0.58]. Patients who had crescents and/or necrotizing lesions on biopsy were more likely to be immunosuppressed (odds ratio 9.99; 95% CI 1.99-50.06, P = 0.005) but demonstrated a statistically nonsignificant higher hazard for both renal end points (HR, 1.61; CI 0.19-13.89). Such lesions were also associated with a higher incidence of hypertension (149 vs. 135 mm Hg) and greater proteinuria (2.7 vs. 1.9 g/day) at presentation. The use of the Oxford Classification did not aid decision-making with regard to the use of immunosuppression. Crescents and/or necrosis identified on histology were associated with the use of immunosuppression. Hence, there is a need for these lesions to be evaluated further in large cohorts and incorporated into future disease classifications.
许多研究探讨了牛津分类法中病理结果的预测价值。这是否会影响治疗选择尚未确定。我们评估了接受免疫抑制治疗的IgA肾病患者，并将我们的研究结果与牛津分类法中的临床和组织学特征进行了关联。这是一项对45例经活检证实为IgA肾病患者的回顾性观察研究，平均随访时间为2.6年。主要结局是终末期肾病（ESRD）的发生时间或血清肌酐升高50%。免疫抑制与ESRD和血清肌酐升高50%的较低风险无关。根据牛津分类法，只有T0与ESRD的显著较低风险相关[风险比（HR），0.067；置信区间（CI）0.01 - 0.58]。活检时有新月体和/或坏死性病变的患者更有可能接受免疫抑制治疗（优势比9.99；95% CI 1.99 - 50.06，P = 0.005），但在两个肾脏终点方面显示出统计学上无显著差异的较高风险（HR，1.61；CI 0.19 - 13.89）。这些病变在出现时还与更高的高血压发病率（149 vs. 135 mmHg）和更大的蛋白尿（2.7 vs. 1.9 g/天）相关。牛津分类法在免疫抑制治疗的决策方面并无帮助。组织学上发现的新月体和/或坏死与免疫抑制治疗有关。因此，需要在大型队列中对这些病变进行进一步评估，并纳入未来的疾病分类中。
