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

Daniel C. Cattran, Rosanna Coppo, H. Terence Cook, John Feehally, Ian S D Roberts, Stéphan Troyanov, Charles E. Alpers, Alessandro Amore, Jonathan Barratt, Francois Berthoux, Stephen Bonsib, Jan A. Bruijn, Vivette D'Agati, Giuseppe D'Amico, Steven Emancipator, Francesco Emma, Franco Ferrario, Fernando C. Fervenza, Sandrine Florquin, Agnes FogoColin C. Geddes, Hermann Josef Groene, Mark Haas, Andrew M. Herzenberg, Prue A. Hill, Ronald J. Hogg, Stephen I. Hsu, J. Charles Jennette, Kensuke Joh, Bruce A. Julian, Tetsuya Kawamura, Fernand M. Lai, Chi Bon Leung, Lei Shi Li, Philip K T Li, Zhi Hong Liu, Bruce MacKinnon, Sergio Mezzano, F. Paolo Schena, Yasuhiko Tomino, Patrick D. Walker, Haiyan Wang, Jan J. Weening, Nori Yoshikawa, Hong Zhang

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)534-545
Number of pages12
JournalKidney International
Volume76
Issue number5
DOIs
Publication statusPublished - Sep 2009

Keywords

  • Glomerulonephritis
  • IgA nephropathy
  • Oxford classification
  • Pathology
  • Renal failure

ASJC Scopus subject areas

  • Nephrology

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    Cattran, D. C., Coppo, R., Cook, H. T., Feehally, J., Roberts, I. S. D., Troyanov, S., Alpers, C. E., Amore, A., Barratt, J., Berthoux, F., Bonsib, S., Bruijn, J. A., D'Agati, V., D'Amico, G., Emancipator, S., Emma, F., Ferrario, F., Fervenza, F. C., Florquin, S., ... Zhang, H. (2009). The Oxford classification of IgA nephropathy: Rationale, clinicopathological correlations, and classification. Kidney International, 76(5), 534-545. https://doi.org/10.1038/ki.2009.243