A Multicenter Application and Evaluation of the Oxford Classification of IgA Nephropathy in Adult Chinese Patients

被引：247

作者：

Zeng, Cai-Hong ^{[1
]}

Le, Weibo ^{[1
]}

Ni, Zhaohui ^{[2
]}

Zhang, Minfang ^{[2
]}

Miao, Lining ^{[3
]}

Luo, Ping ^{[3
]}

Wang, Rong ^{[4
]}

Lv, Zhimei ^{[4
]}

Chen, Jianghua ^{[5
]}

Tian, Jiong ^{[5
]}

Chen, Nan ^{[6
]}

Pan, Xiaoxia ^{[6
]}

Fu, Ping ^{[7
]}

Hu, Zhangxue ^{[7
]}

Wang, Lining ^{[8
]}

Fan, Qiuling ^{[8
]}

Zheng, Hongguang ^{[9
]}

Zhang, Dewei ^{[9
]}

Wang, Yaping ^{[10
]}

Huo, Yanhong ^{[10
]}

Lin, Hongli ^{[11
]}

Chen, Shuni ^{[11
]}

Sun, Shiren ^{[12
]}

Wang, Yanxia ^{[12
]}

Liu, Zhangsuo ^{[13
]}

Liu, Dong ^{[13
]}

Ma, Lu

Pan, Tao

Zhang, Aiping ^{[14
]}

Jiang, Xiaoyu ^{[14
]}

Xing, Changying ^{[15
]}

Sun, Bing ^{[15
]}

Zhou, Qiaoling ^{[16
,17
]}

Tang, Wenbing ^{[16
,17
]}

Liu, Fuyou ^{[16
,18
]}

Liu, Yinghong ^{[16
,18
]}

Liang, Shaoshan ^{[1
]}

Xu, Feng ^{[1
]}

Huang, Qian ^{[1
]}

Shen, Hongbing ^{[19
,20
]}

Wang, Jianming ^{[19
,20
]}

Shyr, Yu ^{[21
]}

Phillips, Sharon ^{[21
]}

Trojanov, Stephan ^{[22
]}

Fogo, Agnes ^{[23
]}

Liu, Zhi-Hong ^{[1
]}

机构：

[1] Nanjing Univ, Jinling Hosp, Sch Med, Res Inst Nephrol, Nanjing 210002, Jiangsu, Peoples R China

[2] Shanghai Jiao Tong Univ, Div Renal, Renji Hosp, Sch Med, Shanghai 200030, Peoples R China

[3] Jilin Univ, Hosp 2, Dept Nephrol, Changchun 130023, Peoples R China

[4] Shandong Univ, Dept Kidney, Shandong Prov Hosp, Jinan 250100, Peoples R China

[5] Zhejiang Univ, Sch Med, Affiliated Hosp 1, Kidney Dis Ctr, Hangzhou 310003, Zhejiang, Peoples R China

[6] Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Nephrol, Shanghai 200030, Peoples R China

[7] Sichuan Univ, W China Hosp, Div Nephrol, Chengdu 610064, Peoples R China

[8] China Med Univ, Hosp 1, Dept Nephrol, Shenyang, Peoples R China

[9] Gen Hosp Shenyang Mil Command, Dept Nephrol, Shenyang, Peoples R China

[10] Gen Hosp Beijing Mil Army, Ctr Diag & Treatment Kidney Dis Beijing PLA, Beijing, Peoples R China

[11] Dalian Med Univ, Affiliated Hosp 1, Dept Nephrol, Dalian, Peoples R China

[12] Fourth Mil Med Univ, Xijing Hosp, Dept Nephrol, Xian 710032, Peoples R China

[13] Zhengzhou Univ, Affiliated Hosp 1, Dept Nephrol, Zhengzhou, Peoples R China

[14] Gen Hosp Jinan Command, Dept Nephrol, Jinan, Peoples R China

[15] Nanjing Med Univ, Affiliated Hosp 1, Dept Nephrol, Nanjing, Jiangsu, Peoples R China

[16] Cent S Univ, Kidney Inst, Changsha, Hunan, Peoples R China

[17] Xiangya Hosp, Dept Nephrol, Changsha, Hunan, Peoples R China

[18] Second Xiangya Hosp, Dept Nephrol, Changsha, Hunan, Peoples R China

[19] Nanjing Med Univ, Dept Epidemiol & Biostat, Sch Publ Hlth, Nanjing, Jiangsu, Peoples R China

[20] Nanjing Med Univ, Minist Educ Key Lab Modern Toxicol, Sch Publ Hlth, Nanjing, Jiangsu, Peoples R China

[21] Vanderbilt Univ, Med Ctr, Vanderbilt Ctr Quantitat Sci, Nashville, TN USA

[22] Univ Toronto, Toronto Gen Hosp, Div Nephrol, Toronto, ON M5S 1A1, Canada

[23] Vanderbilt Univ, Med Ctr, Dept Pathol Microbiol & Immunol, Nashville, TN USA

来源：

AMERICAN JOURNAL OF KIDNEY DISEASES | 2012年 / 60卷 / 05期

基金：

中国国家自然科学基金;

关键词：

Clinical epidemiology; immunoglobulin A (IgA) nephropathy; Oxford classification of IgA nephropathy; LONG-TERM; PROGNOSTIC INDICATORS; RISK-FACTORS; CORTICOSTEROIDS; VALIDATION; PREDICTORS; DISEASES;

D O I：

10.1053/j.ajkd.2012.06.011

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

100201 [内科学]; 100221 [泌尿外科学];

摘要：

Background: The Oxford classification of immunoglobulin A (IgA) nephropathy (IgAN) provides a histopathologic grading system that is associated with kidney disease outcomes independent of clinical features. We evaluated the Oxford IgAN classification in a large cohort of patients from China. Study Design: Retrospective study. Setting & Participants: 1,026 adults with IgAN from 18 referral centers in China. Inclusion criteria and statistical analysis were similar to the Oxford study. Predictors: Histologic findings of mesangial hypercellularity score, endocapillary proliferation, segmental sclerosis or adhesion, crescents, necrosis, and tubular atrophy/interstitial fibrosis. Clinical features, blood pressure, estimated glomerular filtration rate (eGFR), proteinuria, and treatment modalities. Outcomes: Time to a 50% reduction in eGFR or end-stage renal disease (the combined event); the rate of eGFR decline (slope of eGFR); proteinuria during follow-up. Results: Compared with the Oxford cohort, the Chinese cohort had a lower proportion of patients with mesangial hypercellularity (43%) and endocapillary proliferation (11%), higher proportion with segmental sclerosis or adhesion (83%) and necrosis (15%), and similar proportion with crescents (48%) and tubular atrophy/interstitial fibrosis (moderate, 24%; severe, 3.3%). During a median follow-up of 53 (25th-75th percentile, 36-67) months, 159 (15.5%) patients reached the combined event. Our study showed that patients with a mesangial hypercellularity score higher than 0.5 were associated with a 2.0-fold (95% CI, 1.5-2.8; P < 0.001) higher risk of the combined event than patients with a score of 0.5 or lower. Patients with tubularatrophy/interstitial fibrosis of 25%-50% and >50% versus <25% were associated with a 3.7-fold (95% CI, 2.6-5.1; P<0.001) and 15.1-fold (95% CI, 9.5-24.2; P<0.001) higher risk of the combined event, respectively. Endocapillary proliferation, glomerular crescents, and necrosis were not significant. Limitations: Retrospective study; the therapeutic interventions were miscellaneous. Conclusions: We confirmed the associations of mesangial hypercellularity and tubular atrophy/interstitial fibrosis with kidney disease outcomes. Am J Kidney Dis. 60(5):812-820. (C) 2012 by the National Kidney Foundation, Inc.

引用

页码：812 / 820

页数：9

共 32 条

[1]

ALAMARTINE E, 1993, ANN MED INTERNE, V144, P317

[2]

The Use of the Oxford Classification of IgA Nephropathy to Predict Renal Survival [J].

Alamartine, Eric ;

Sauron, Catherine ;

Laurent, Blandine ;

Sury, Aurore ;

Seffert, Aline ;

Mariat, Christophe .

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2011, 6 (10) :2384-2388

[3]

ARMSTRONG GD, 1981, NURS RES, V30, P314

[4]

Armstrong GD, 1981, NURS RES, V30, P320

[5]

Comparative study of IgA nephropathy with and without cresents [J].

Bitencourt-Dias, C ;

Bahiense-Oliveira, M ;

Saldanha, LB ;

Barros, RT ;

Woronik, V .

BRAZILIAN JOURNAL OF MEDICAL AND BIOLOGICAL RESEARCH, 2004, 37 (09) :1373-1377

[6]

CLINICOPATHOLOGICAL ASSOCIATIONS IN MESANGIAL IGA NEPHROPATHY [J].

BOYCE, NW ;

HOLDSWORTH, SR ;

THOMSON, NM ;

ATKINS, RC .

AMERICAN JOURNAL OF NEPHROLOGY, 1986, 6 (04) :246-252

[7]

The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification [J].

Cattran, Daniel C. ;

Coppo, Rosanna ;

Cook, H. Terence ;

Feehally, John ;

Roberts, Ian S. D. ;

Troyanov, Stephan ;

Alpers, Charles E. ;

Amore, Alessandro ;

Barratt, Jonathan ;

Berthoux, Francois ;

Bonsib, Stephen ;

Bruijn, Jan A. ;

D'Agati, Vivette ;

D'Amico, Giuseppe ;

Emancipator, Steven ;

Emma, Francesco ;

Ferrario, Franco ;

Fervenza, Fernando C. ;

Florquin, Sandrine ;

Fogo, Agnes ;

Geddes, Colin C. ;

Groene, Hermann-Josef ;

Haas, Mark ;

Herzenberg, Andrew M. ;

Hill, Prue A. ;

Hogg, Ronald J. ;

Hsu, Stephen I. ;

Jennette, J. Charles ;

Joh, Kensuke ;

Julian, Bruce A. ;

Kawamura, Tetsuya ;

Lai, Fernand M. ;

Leung, Chi Bon ;

Li, Lei-Shi ;

Li, Philip K. T. ;

Liu, Zhi-Hong ;

Mackinnon, Bruce ;

Mezzano, Sergio ;

Schena, F. Paolo ;

Tomino, Yasuhiko ;

Walker, Patrick D. ;

Wang, Haiyan ;

Weening, Jan J. ;

Yoshikawa, Nori ;

Zhang, Hong .

KIDNEY INTERNATIONAL, 2009, 76 (05) :534-545

[8]

Presentation, prognosis and outcome of IgA nephropathy in Indian adults [J].

Chacko, B ;

John, GT ;

Neelakantan, N ;

Korula, A ;

Balakrishnan, N ;

Kirubakaran, MG ;

Jacob, CK .

NEPHROLOGY, 2005, 10 (05) :496-503

[9]

Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome [J].

D'Amico, G .

SEMINARS IN NEPHROLOGY, 2004, 24 (03) :179-196

[10]

Idiopathic IgA nephropathy with segmental necrotizing lesions of the capillary wall [J].

D'Amico, G ;

Napodano, P ;

Ferrario, F ;

Rastaldi, MP ;

Arrigo, G .

KIDNEY INTERNATIONAL, 2001, 59 (02) :682-692

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