The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification

被引：1020

作者：

Cattran, Daniel C. ^{[2
]}

Coppo, Rosanna ^{[3
]}

Cook, H. Terence ^{[5
]}

Feehally, John ^{[1
]}

Roberts, Ian S. D. ^{[4
]}

Troyanov, Stephan ^{[6
]}

Alpers, Charles E. ^{[7
]}

Amore, Alessandro ^{[3
]}

Barratt, Jonathan ^{[1
]}

Berthoux, Francois ^{[8
]}

Bonsib, Stephen ^{[9
]}

Bruijn, Jan A. ^{[10
]}

D'Agati, Vivette ^{[11
]}

D'Amico, Giuseppe ^{[12
]}

Emancipator, Steven ^{[13
]}

Emma, Francesco ^{[14
]}

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. ^{[32
]}

Leung, Chi Bon ^{[31
]}

Li, Lei-Shi ^{[33
]}

Li, Philip K. T. ^{[31
]}

Liu, Zhi-Hong ^{[33
]}

Mackinnon, Bruce ^{[19
]}

Mezzano, Sergio ^{[34
]}

Schena, F. Paolo ^{[35
]}

Tomino, Yasuhiko ^{[36
]}

Walker, Patrick D. ^{[37
]}

Wang, Haiyan ^{[38
]}

Weening, Jan J. ^{[39
]}

Yoshikawa, Nori ^{[40
]}

Zhang, Hong ^{[38
]}

机构：

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

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

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

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

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

[6] Univ Montreal, Hop Sacre Coeur Montreal, Quebec City, PQ, Canada

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

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

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

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

[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, Div Nephrol & Dialysis, Dept Nephrol & Urol, 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, Div Immunopathol, Clin Res Ctr Chiba, Chiba, Japan

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

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

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

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

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

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

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

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

[37] Nephropathol Associates, Little Rock, AR USA

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

[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; GLOMERULAR-FILTRATION-RATE; NATURAL-HISTORY; RENAL-DISEASE; PROTEINURIA; PROGRESSION; CHILDREN; GLOMERULONEPHRITIS; PROGNOSIS; LESIONS; ADULTS;

D O I：

10.1038/ki.2009.243

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：

IgA nephropathy is the most common glomerular disease worldwide, yet there is no international consensus for its pathological or clinical classification. Here a new classification for IgA nephropathy is presented by an international consensus working group. The goal of this new system was to identify specific pathological features that more accurately predict risk of progression of renal disease in IgA nephropathy, thus enabling both clinicians and pathologists to improve individual patient prognostication. In a retrospective analysis, sequential clinical data were obtained on 265 adults and children with IgA nephropathy who were followed for a median of 5 years. Renal biopsies from all patients were scored by pathologists blinded to the clinical data for pathological variables identified as reproducible by an iterative process. Four of these variables: (1) the mesangial hypercellularity score, (2) segmental glomerulosclerosis, (3) endocapillary hypercellularity, and (4) tubular atrophy/interstitial fibrosis were subsequently shown to have independent value in predicting renal outcome. These specific pathological features withstood rigorous statistical analysis even after taking into account all clinical indicators available at the time of biopsy as well as during follow-up. The features have prognostic significance and we recommended they be taken into account for predicting outcome independent of the clinical features both at the time of presentation and during follow- up. The value of crescents was not addressed due to their low prevalence in the enrolled cohort.

引用

页码：534 / 545

页数：12

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