Validation of the Oxford classification of IgA nephropathy.

Herzenberg AM, Fogo AB, Reich HN, Troyanov S, Bavbek N, Massat AE, Hunley TE, Hladunewich MA, Julian BA, Fervenza FC, Cattran DC
Kidney Int. 2011 80 (3): 310-7

PMID: 21544062 · DOI:10.1038/ki.2011.126

The Oxford classification of IgA nephropathy (IgAN) identified four pathological elements that were of prognostic value and additive to known clinical and laboratory variables in predicting patient outcome. These features are segmental glomerulosclerosis/adhesion, mesangial hypercellularity, endocapillary proliferation, and tubular atrophy/interstitial fibrosis. Here, we tested the Oxford results using an independent cohort of 187 adults and children with IgAN from 4 centers in North America by comparing the performance of the logistic regression model and the predictive value of each of the four lesions in both data sets. The cohorts had similar clinical and histological findings, presentations, and clinicopathological correlations. During follow-up, however, the North American cohort received more immunosuppressive and antihypertensive therapies. Identifying patients with a rapid decline in the rate of renal function using the logistic model from the original study in the validation data set was good (c-statistic 0.75), although less precise than in the original study (0.82). Individually, each pathological variable offered the same predictive value in both cohorts except mesangial hypercellularity, which was a weaker predictor. Thus, this North American cohort validated the Oxford IgAN classification and supports its utilization. Further studies are needed to determine the relationship to the impact of treatment and to define the value of the mesangial hypercellularity score.

MeSH Terms (33)

Adolescent Adult Analysis of Variance Antihypertensive Agents Atrophy Biopsy Canada Capillaries Chi-Square Distribution Female Fibrosis Glomerular Filtration Rate Glomerulonephritis, IGA Glomerulosclerosis, Focal Segmental Humans Immunosuppressive Agents Kidney Least-Squares Analysis Logistic Models Male Mesangial Cells Middle Aged Odds Ratio Predictive Value of Tests Prognosis Proportional Hazards Models Reproducibility of Results Retrospective Studies Severity of Illness Index Terminology as Topic Time Factors United States Young Adult

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