The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility

被引：831

作者：

Roberts, Ian S. D. ^{[1
]}

Cook, H. Terence ^{[2
]}

Troyanov, Stephan ^{[3
]}

Alpers, Charles E. ^{[4
]}

Amore, Alessandro ^{[5
]}

Barratt, Jonathan ^{[6
]}

Berthoux, Francois ^{[7
]}

Bonsib, Stephen ^{[8
]}

Bruijn, Jan A. ^{[9
]}

Cattran, Daniel C. ^{[10
]}

Coppo, Rosanna ^{[5
]}

D'Agati, Vivette ^{[11
]}

D'Amico, Giuseppe ^{[12
]}

Emancipator, Steven ^{[13
]}

Emma, Francesco ^{[14
]}

Feehally, John ^{[6
]}

Ferrario, Franco ^{[15
]}

Fervenza, Fernando C. ^{[16
]}

Florquin, Sandrine ^{[17
]}

Fogo, Agnes ^{[18
]}

Geddes, Colin C. ^{[19
]}

Groene, Hermann-Josef ^{[20
]}

Haas, Mark ^{[21
]}

Herzenberg, Andrew M. ^{[22
,23
]}

Hill, Prue A. ^{[24
]}

Hogg, Ronald J. ^{[25
]}

Hsu, Stephen I. ^{[26
]}

Jennette, J. Charles ^{[27
]}

Joh, Kensuke ^{[28
]}

Julian, Bruce A. ^{[29
]}

Kawamura, Tetsuya ^{[30
]}

Lai, Fernand M. ^{[31
]}

Li, Lei-Shi ^{[32
]}

Li, Philip K. T. ^{[33
]}

Liu, Zhi-Hong ^{[32
]}

Mackinnon, Bruce ^{[19
]}

Mezzano, Sergio ^{[34
]}

Schena, F. Paolo ^{[35
]}

Tomino, Yasuhiko ^{[36
]}

Walker, Patrick D. ^{[38
]}

Wang, Haiyan ^{[37
]}

Weening, Jan J. ^{[39
]}

Yoshikawa, Nori ^{[40
]}

Zhang, Hong ^{[37
]}

机构：

[1] John Radcliffe Hosp, Dept Cellular Pathol, Oxford OX3 9DU, England

[2] Univ London Imperial Coll Sci Technol & Med, London, England

[3] Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[4] Univ Washington, Med Ctr, Dept Pathol, Seattle, WA 98195 USA

[5] Univ Turin, Nephrol Dialysis & Transplantat Unit, Regina Margherita Childrens Hosp, Turin, Italy

[6] Leicester Gen Hosp, John Walls Renal Unit, Leicester LE5 4PW, Leics, England

[7] CHU St Etienne, Hop Nord, Dept Nephrol Dialysis & Renal Transplantat, St Etienne, France

[8] LSU Hlth Sci Ctr, Dept Pathol, Shreveport, LA USA

[9] Leiden Univ, Dept Pathol, Med Ctr, Leiden, Netherlands

[10] Toronto Gen Res Inst, Univ Hlth Network, Toronto, ON, Canada

[11] Columbia Univ Coll Phys & Surg, Dept Pathol, New York, NY 10032 USA

[12] Fdn DAmico Ric Malattie Renali, Milan, Italy

[13] Case Western Reserve Univ, Dept Pathol, Cleveland, OH 44106 USA

[14] Bambino Gesu Childrens Hosp & Res Inst, Dept Nephrol & Urol, Div Nephrol & Dialysis, Rome, Italy

[15] San Carlo Borromeo Hosp, Renal Immunopathol Ctr, Milan, Italy

[16] Mayo Clin, Div Nephrol & Hypertens, Rochester, MN USA

[17] Univ Amsterdam, Acad Med Ctr, Dept Pathol, NL-1105 AZ Amsterdam, Netherlands

[18] Vanderbilt Univ, Dept Pathol, Nashville, TN USA

[19] Univ Glasgow, Western Infirm, Renal Unit, Glasgow G11 6NT, Lanark, Scotland

[20] German Canc Res Ctr, Dept Cellular & Mol Pathol, D-6900 Heidelberg, Germany

[21] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21205 USA

[22] Univ Hlth Network, Dept Pathol, Toronto, ON, Canada

[23] Univ Toronto, Toronto, ON M5S 1A1, Canada

[24] St Vincents Hosp, Melbourne, Vic, Australia

[25] Scott & White Med Ctr, Temple, TX USA

[26] Univ Florida, Coll Med, Div Nephrol Hypertens & Renal Transplantat, Gainesville, FL USA

[27] Univ N Carolina, Dept Pathol & Lab Med, Chapel Hill, NC USA

[28] E Natl Hosp, Clin Res Ctr Chiba, Div Immunopathol, Chiba, Japan

[29] Univ Alabama, Dept Med, Birmingham, AL 35294 USA

[30] Jikei Univ, Sch Med, Div Nephrol & Hypertens, Tokyo, Japan

[31] Chinese Univ Hong Kong, Hong Kong, Hong Kong, Peoples R China

[32] Nanjing Univ, Res Inst Nephrol, Jinling Hosp, Sch Med, Nanjing 210008, Peoples R China

[33] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med, Hong Kong, Hong Kong, Peoples R China

[34] Univ Austral Chile, Escuela Med, Dept Nefrol, Valdivia, Chile

[35] Policlin, Renal Dialysis & Transplant Unit, Bari, Italy

[36] Juntendo Univ, Sch Med, Div Nephrol, Dept Internal Med, Tokyo 113, Japan

[37] Peking Univ, Div Renal, Hosp 1, Inst Nephrol, Beijing 100871, Peoples R China

[38] Nephropathol Associates, Little Rock, AR USA

[39] Erasmus MC, Rotterdam, Netherlands

[40] Wakayama Med Univ, Dept Pediat, Wakayama, Japan

来源：

KIDNEY INTERNATIONAL | 2009年 / 76卷 / 05期

关键词：

glomerulonephritis; IgA nephropathy; Oxford classification; pathology; renal failure; LUPUS-NEPHRITIS; PROGNOSTIC INDICATORS; RENAL-DISEASE; LESIONS; RELIABILITY; PROGRESSION; AGREEMENT; CHILDREN; JAPANESE;

D O I：

10.1038/ki.2009.168

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：

1002 ; 100201 ;

摘要：

Pathological classifications in current use for the assessment of glomerular disease have been typically opinion-based and built on the expert assumptions of renal pathologists about lesions historically thought to be relevant to prognosis. Here we develop a unique approach for the pathological classification of a glomerular disease, IgA nephropathy, in which renal pathologists first undertook extensive iterative work to define pathologic variables with acceptable inter-observer reproducibility. Where groups of such features closely correlated, variables were further selected on the basis of least susceptibility to sampling error and ease of scoring in routine practice. This process identified six pathologic variables that could then be used to interrogate prognostic significance independent of the clinical data in IgA nephropathy (described in the accompanying article). These variables were (1) mesangial cellularity score; percentage of glomeruli showing (2) segmental sclerosis, (3) endocapillary hypercellularity, or (4) cellular/fibrocellular crescents; (5) percentage of interstitial fibrosis/tubular atrophy; and finally (6) arteriosclerosis score. Results for interobserver reproducibility of individual pathological features are likely applicable to other glomerulonephritides, but it is not known if the correlations between variables depend on the specific type of glomerular pathobiology. Variables identified in this study withstood rigorous pathology review and statistical testing and we recommend that they become a necessary part of pathology reports for IgA nephropathy. Our methodology, translating a strong evidence-based dataset into a working format, is a model for developing classifications of other types of renal disease.

引用

页码：546 / 556

页数：11

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