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Validity of the Oxford classification of IgA nephropathy in children
Yuko Shima1, Koichi Nakanishi, Taketsugu Hama
1Department of Pediatrics, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama 641-8509, Japan.
Insights
The Oxford classification for IgA nephropathy is valid in children, predicting kidney disease progression. Key factors like mesangial hypercellularity and tubular atrophy are significant indicators.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
Background:
- The Oxford classification for IgA nephropathy (IgAN) was established in 2009.
- Its predictive validity in pediatric cohorts remains under-examined.
Purpose of the Study:
- To evaluate the Oxford classification's effectiveness in predicting renal outcomes in children with IgAN.
- To assess individual Oxford classification variables as predictors of chronic kidney disease (CKD) progression.
Main Methods:
- Retrospective analysis of 161 children diagnosed with IgAN between 1977 and 1989.
- Cox regression analysis to determine the predictive ability of Oxford classification variables for renal outcome (≥ stage III CKD).
Main Results:
- Mesangial hypercellularity, tubular atrophy, and crescents were significant predictors of renal outcome in multivariate analysis.
- Segmental glomerulosclerosis was not a significant predictor.
- Crescents, though not explicitly addressed in the original classification, proved to be important outcome predictors.
Conclusions:
- The Oxford classification system demonstrates validity for predicting renal outcomes in pediatric IgA nephropathy.
- Specific histological features are crucial for risk stratification in children with IgAN.
Background:
In 2009, the Oxford classification of IgA nephropathy was published. However, its validity has not been fully examined in children. This study aimed to assess this system in an independent large-scale cohort of children.
Methods:
We analyzed 161 consecutive children with newly diagnosed IgA nephropathy from 1977 to 1989 retrospectively. We examined the ability of each variable in the Oxford classification as a predictor of renal outcome defined as ≥ stage III chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2)) using Cox regression analysis.
Results:
The mean mesangial score, and ratios of segmental glomerulosclerosis, endocapillary hypercellularity, tubular atrophy, and crescents were 0.49, 0.8%, 13.1%, 3.3%, and 9.2% respectively. Seven cases reached ≥ stage III CKD. In univariate analyses, mesangial hypercellularity score, endocapillary hypercellularity, tubular atrophy, and crescents were significant predictors of renal outcome. In a multivariate analysis, only mesangial hypercellularity score, tubular atrophy, and crescents were significant though, depending on models. Segmental glomerulosclerosis was not a significant predictor of renal outcome. Although the significance of crescents was not addressed in the Oxford classification, crescents were important predictors of outcome.
Conclusions:
The Oxford classification appears to be valid for predicting renal outcome in children.
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