Journal
KIDNEY INTERNATIONAL
Volume 80, Issue 3, Pages 310-317Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ki.2011.126
Keywords
clinical epidemiology; glomerulonephritis; IgA nephropathy; pathology; statistics
Categories
Funding
- Kidney Foundation of Canada
- Canadian Institute of Health Research
- Fonds de la Recherche en Sante du Quebec
- Net Grant on Genes, Gender and Glomerulonephritis [452773L]
- Fonds de la Recherche en Sante du Quebec [14395]
- NIH [DK082753, DK078244, DK080301]
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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.
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