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Association of Renal CD68+ Cell Infiltration with Oxford Classification in IgA Nephropathy
Mitra Mehrazma1, Fatemeh Gharehdaghli2, Shahrzad Ossareh3
1Department of Pathology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Introduction:
IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. The Oxford classification (MEST-C) a standardized histopathological scoring system evaluating mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), interstitial fibrosis/tubular atrophy (T), and cellular or fibrocellular crescents (C), provides a histopathological framework to predict disease progression. However, the role of immune cell infiltration-particularly CD68+ macrophages-in these pathological features remains underexplored.
Objective:
To investigate the association between renal CD68+ macrophage infiltration and the Oxford classification parameters in patients with IgA nephropathy.
Methods:
This study included 146 patients with biopsy-proven IgAN at Hasheminejad Kidney Center between 2013 and 2020. Immunohistochemical staining for CD68 was performed on paraffin-embedded kidney biopsy sections. CD68+ macrophages were quantified separately in the glomerular and interstitial compartments. Finally, the associations between macrophage counts and Oxford classification components (M, E, S, T, C) were analyzed.
Results:
Glomerular CD68+ cell counts were significantly higher in samples with M1, E1, T1, and C1 lesions (P < .05). Interstitial CD68+ cells were significantly elevated in T1 lesions (mean: 10.6 vs. 4.7 in T0; P < .001). Receiver operating characteristic (ROC) analysis demonstrated high diagnostic accuracy for interstitial CD68+ cells in predicting T1 (AUC = 0.98) and for glomerular CD68⁺ macrophage in predicting E1 (AUC = 0.88).
Conclusion:
CD68+ macrophage infiltration is closely associated with active and chronic lesions in IgAN, particularly endocapillary hypercellularity and tubular atrophy. Quantification of CD68+ macrophage may serve as a valuable histological marker for assessing disease activity and guiding prognosis in IgAN.
