Moreno Jhonny L, Rodas Lida M, Draibe Juliana, Fulladosa Xavier, Gomá Montserrat, Garcia-Herrera Adriana, Cruzado Josep M, Torras Joan, Quintana Luis F
Department of Nephrology, Bellvitge University Hospital, Barcelona, Spain.
Department of Nephrology and Renal Transplantation, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic-University of Barcelona, Barcelona, Spain.
Clin Kidney J. 2019 Nov 9;14(1):284-290. doi: 10.1093/ckj/sfz133. eCollection 2021 Jan.
The revised Oxford classification of diagnostic renal biopsies has been proposed to aid in the prediction of renal outcome. We aimed to validate the histological crescents and interstitial fibrosis and tubular atrophy (IFTA) subgrouping, and to investigate the additional value of the proportion of crescents (CatPE) in the prediction of renal outcome.
Data were retrospectively collected over 10 years, from the time of diagnosis, by systematic review of medical records from 90 patients with renal biopsies recruited to cohorts from two hospitals in Spain. Patients were classified into three groups for the analysis: CatPE >25% (C2), CatPE <25% (C1) and without this type of lesion (C0). The end point was renal survival defined by either >50% reduction in glomerular filtrate rate or end-stage renal disease.
Renal survival at 5 years was 90% in group C0, 81% in group C1 and 31% in group C2 (P = 0.013). The presence of >25% crescents in the sample was associated with more severe disease when compared with <25%, as demonstrated by more interstitial fibrotic change and by lower estimated glomerular filtration rate at diagnosis, as well as worse renal function at 2 and 5 years. At the time of diagnosis and at 24 months, the group with IFTA >50% had poorer renal function compared with the other groups.
We have confirmed the predictive value for renal survival of the revised Oxford classification in a two-centre study. We found worse renal outcome in patients with severe tubulointerstitial fibrosis and atrophy. Patients with extracapillary lesions >25% and IFTA >50% had a worse renal prognosis due to more severe kidney injury. These results contribute to patient stratification in immunoglobulin A nephropathy for therapeutic, epidemiological and basic research.
修订后的牛津诊断性肾活检分类法已被提出用于辅助预测肾脏预后。我们旨在验证组织学新月体及间质纤维化和肾小管萎缩（IFTA）亚组分类，并研究新月体比例（CatPE）在预测肾脏预后方面的附加价值。
通过系统回顾西班牙两家医院招募入队列研究的90例肾活检患者的病历资料，回顾性收集了从诊断时起10年的数据。患者被分为三组进行分析：CatPE>25%（C2组）、CatPE<25%（C1组）和无此类病变（C0组）。终点为肾脏存活，定义为肾小球滤过率降低>50%或终末期肾病。
C0组5年肾脏存活率为90%，C1组为81%，C2组为31%（P = 0.013）。与<25%相比，样本中新月体>25%与更严重的疾病相关，表现为更多的间质纤维化改变、诊断时更低的估计肾小球滤过率以及2年和5年时更差的肾功能。在诊断时和24个月时，IFTA>50%的组肾功能较其他组更差。
我们在一项双中心研究中证实了修订后的牛津分类法对肾脏存活的预测价值。我们发现严重肾小管间质纤维化和萎缩的患者肾脏预后更差。毛细血管外病变>25%且IFTA>50%的患者由于肾脏损伤更严重，肾脏预后更差。这些结果有助于在免疫球蛋白A肾病中对患者进行分层，以用于治疗、流行病学和基础研究。
