Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments

Rosanna Coppo, Stéphan Troyanov, Shubha Bellur, Daniel Cattran, H. Terence Cook, John Feehally, Ian S D Roberts, Laura Morando, Roberta Camilla, Vladimir Tesar, Sigrid Lunberg, Loreto Gesualdo, Francesco Emma, Cristiana Rollino, Alessandro Amore, Manuel Praga, Sandro Feriozzi, Giuseppe Segoloni, Antonello Pani, Giovanni CancariniMagalena Durlik, Elisabetta Moggia, Gianna Mazzucco, Costantinos Giannakakis, Eva Honsova, B. Brigitta Sundelin, Anna Maria Di Palma, Franco Ferrario, Eduardo Gutierrez, Anna Maria Asunis, Jonathan Barratt, Regina Tardanico, Agnieszka Perkowska-Ptasinska, D. Maixnerova, S. Lundberg, L. Fuiano, G. Beltrame, L. Peruzzi, R. Polci, L. Colla, A. Angioi, D. Piras, S. Ravera, J. Ballarin, S. Di Giulio, F. Pugliese, Y. Caliskan, F. Locatelli, L. Del Vecchio, J. F M Wetzels, H. Peters, U. Berg, F. Carvalho, M. Maggio, A. Wiecek, M. Ots-Rosenberg, R. Magistroni, R. Topaloglu, Y. Bilginer, M. D'Amico, M. Stangou, F. Giacchino, D. Goumenos, P. Kalliakmani, M. Gerolymos, K. Galesic, C. Geddes, K. Siamopoulos, O. Balafa, M. Galliani, P. Stratta, M. Quaglia, R. Bergia, R. Cravero, M. Salvadori, L. Cirami, B. Fellstrom, H. Kloster Smerud, T. Stellato, J. Egido, C. Martin, J. Floege, F. Eitner, A. Lupo, P. Bernich, P. Menè, M. Morosetti, C. Van Kooten, T. Rabelink, M. E J Reinders, J. M. Boria Grinyo, S. Cusinato, L. Benozzi, S. Savoldi, C. Licata, M. Mizerska Wasiak, G. Martina, A. Messuerotti, A. Dal Canton, C. Esposito, C. Migotto, G. Triolo, F. Mariano, C. Pozzi, R. Boero, F. Ferrario, E. Gutiérrez, J. Arce Terroba, M. Fortunato, Y. Ozluk, I. Kilicaslan, E. Steenberger, M. Soderberg, A. C. Da Costa Ferreira, Z. Riispere, L. Furci, D. Orhan, D. Kipgen, D. Casartelli, D. Galesic Ljubanovic, E. Bertoni, P. Cannata Ortiz, H. J. Groene, A. Stoppacciaro, I. Bajema, J. Bruijn, X. Fulladosa Oliveras, J. Maldyk, E. Ioachim

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin-angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m 2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5%). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy.

Original languageEnglish
Pages (from-to)828-836
Number of pages9
JournalKidney International
Volume86
Issue number4
DOIs
Publication statusPublished - Jan 1 2014

Fingerprint

Immunoglobulin A
Immunosuppressive Agents
Glomerular Filtration Rate
Proteinuria
Glucocorticoids
Pathology
Renin-Angiotensin System
Immunosuppression
Atrophy
Fibrosis
Therapeutics
Kidney
Survival
Pharmaceutical Preparations
Segmental glomerulosclerosis

Keywords

  • glomerular diseases
  • IgA nephropathy
  • progression of chronic renal failure
  • proteinuria
  • renal pathology
  • risk factors

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

Cite this

Coppo, R., Troyanov, S., Bellur, S., Cattran, D., Cook, H. T., Feehally, J., ... Ioachim, E. (2014). Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney International, 86(4), 828-836. https://doi.org/10.1038/ki.2014.63

Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. / Coppo, Rosanna; Troyanov, Stéphan; Bellur, Shubha; Cattran, Daniel; Cook, H. Terence; Feehally, John; Roberts, Ian S D; Morando, Laura; Camilla, Roberta; Tesar, Vladimir; Lunberg, Sigrid; Gesualdo, Loreto; Emma, Francesco; Rollino, Cristiana; Amore, Alessandro; Praga, Manuel; Feriozzi, Sandro; Segoloni, Giuseppe; Pani, Antonello; Cancarini, Giovanni; Durlik, Magalena; Moggia, Elisabetta; Mazzucco, Gianna; Giannakakis, Costantinos; Honsova, Eva; Sundelin, B. Brigitta; Palma, Anna Maria Di; Ferrario, Franco; Gutierrez, Eduardo; Asunis, Anna Maria; Barratt, Jonathan; Tardanico, Regina; Perkowska-Ptasinska, Agnieszka; Maixnerova, D.; Lundberg, S.; Fuiano, L.; Beltrame, G.; Peruzzi, L.; Polci, R.; Colla, L.; Angioi, A.; Piras, D.; Ravera, S.; Ballarin, J.; Di Giulio, S.; Pugliese, F.; Caliskan, Y.; Locatelli, F.; Del Vecchio, L.; Wetzels, J. F M; Peters, H.; Berg, U.; Carvalho, F.; Maggio, M.; Wiecek, A.; Ots-Rosenberg, M.; Magistroni, R.; Topaloglu, R.; Bilginer, Y.; D'Amico, M.; Stangou, M.; Giacchino, F.; Goumenos, D.; Kalliakmani, P.; Gerolymos, M.; Galesic, K.; Geddes, C.; Siamopoulos, K.; Balafa, O.; Galliani, M.; Stratta, P.; Quaglia, M.; Bergia, R.; Cravero, R.; Salvadori, M.; Cirami, L.; Fellstrom, B.; Kloster Smerud, H.; Stellato, T.; Egido, J.; Martin, C.; Floege, J.; Eitner, F.; Lupo, A.; Bernich, P.; Menè, P.; Morosetti, M.; Van Kooten, C.; Rabelink, T.; Reinders, M. E J; Boria Grinyo, J. M.; Cusinato, S.; Benozzi, L.; Savoldi, S.; Licata, C.; Mizerska Wasiak, M.; Martina, G.; Messuerotti, A.; Dal Canton, A.; Esposito, C.; Migotto, C.; Triolo, G.; Mariano, F.; Pozzi, C.; Boero, R.; Ferrario, F.; Gutiérrez, E.; Arce Terroba, J.; Fortunato, M.; Ozluk, Y.; Kilicaslan, I.; Steenberger, E.; Soderberg, M.; Da Costa Ferreira, A. C.; Riispere, Z.; Furci, L.; Orhan, D.; Kipgen, D.; Casartelli, D.; Galesic Ljubanovic, D.; Bertoni, E.; Cannata Ortiz, P.; Groene, H. J.; Stoppacciaro, A.; Bajema, I.; Bruijn, J.; Fulladosa Oliveras, X.; Maldyk, J.; Ioachim, E.

In: Kidney International, Vol. 86, No. 4, 01.01.2014, p. 828-836.

Research output: Contribution to journalArticle

Coppo, R, Troyanov, S, Bellur, S, Cattran, D, Cook, HT, Feehally, J, Roberts, ISD, Morando, L, Camilla, R, Tesar, V, Lunberg, S, Gesualdo, L, Emma, F, Rollino, C, Amore, A, Praga, M, Feriozzi, S, Segoloni, G, Pani, A, Cancarini, G, Durlik, M, Moggia, E, Mazzucco, G, Giannakakis, C, Honsova, E, Sundelin, BB, Palma, AMD, Ferrario, F, Gutierrez, E, Asunis, AM, Barratt, J, Tardanico, R, Perkowska-Ptasinska, A, Maixnerova, D, Lundberg, S, Fuiano, L, Beltrame, G, Peruzzi, L, Polci, R, Colla, L, Angioi, A, Piras, D, Ravera, S, Ballarin, J, Di Giulio, S, Pugliese, F, Caliskan, Y, Locatelli, F, Del Vecchio, L, Wetzels, JFM, Peters, H, Berg, U, Carvalho, F, Maggio, M, Wiecek, A, Ots-Rosenberg, M, Magistroni, R, Topaloglu, R, Bilginer, Y, D'Amico, M, Stangou, M, Giacchino, F, Goumenos, D, Kalliakmani, P, Gerolymos, M, Galesic, K, Geddes, C, Siamopoulos, K, Balafa, O, Galliani, M, Stratta, P, Quaglia, M, Bergia, R, Cravero, R, Salvadori, M, Cirami, L, Fellstrom, B, Kloster Smerud, H, Stellato, T, Egido, J, Martin, C, Floege, J, Eitner, F, Lupo, A, Bernich, P, Menè, P, Morosetti, M, Van Kooten, C, Rabelink, T, Reinders, MEJ, Boria Grinyo, JM, Cusinato, S, Benozzi, L, Savoldi, S, Licata, C, Mizerska Wasiak, M, Martina, G, Messuerotti, A, Dal Canton, A, Esposito, C, Migotto, C, Triolo, G, Mariano, F, Pozzi, C, Boero, R, Ferrario, F, Gutiérrez, E, Arce Terroba, J, Fortunato, M, Ozluk, Y, Kilicaslan, I, Steenberger, E, Soderberg, M, Da Costa Ferreira, AC, Riispere, Z, Furci, L, Orhan, D, Kipgen, D, Casartelli, D, Galesic Ljubanovic, D, Bertoni, E, Cannata Ortiz, P, Groene, HJ, Stoppacciaro, A, Bajema, I, Bruijn, J, Fulladosa Oliveras, X, Maldyk, J & Ioachim, E 2014, 'Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments', Kidney International, vol. 86, no. 4, pp. 828-836. https://doi.org/10.1038/ki.2014.63
Coppo, Rosanna ; Troyanov, Stéphan ; Bellur, Shubha ; Cattran, Daniel ; Cook, H. Terence ; Feehally, John ; Roberts, Ian S D ; Morando, Laura ; Camilla, Roberta ; Tesar, Vladimir ; Lunberg, Sigrid ; Gesualdo, Loreto ; Emma, Francesco ; Rollino, Cristiana ; Amore, Alessandro ; Praga, Manuel ; Feriozzi, Sandro ; Segoloni, Giuseppe ; Pani, Antonello ; Cancarini, Giovanni ; Durlik, Magalena ; Moggia, Elisabetta ; Mazzucco, Gianna ; Giannakakis, Costantinos ; Honsova, Eva ; Sundelin, B. Brigitta ; Palma, Anna Maria Di ; Ferrario, Franco ; Gutierrez, Eduardo ; Asunis, Anna Maria ; Barratt, Jonathan ; Tardanico, Regina ; Perkowska-Ptasinska, Agnieszka ; Maixnerova, D. ; Lundberg, S. ; Fuiano, L. ; Beltrame, G. ; Peruzzi, L. ; Polci, R. ; Colla, L. ; Angioi, A. ; Piras, D. ; Ravera, S. ; Ballarin, J. ; Di Giulio, S. ; Pugliese, F. ; Caliskan, Y. ; Locatelli, F. ; Del Vecchio, L. ; Wetzels, J. F M ; Peters, H. ; Berg, U. ; Carvalho, F. ; Maggio, M. ; Wiecek, A. ; Ots-Rosenberg, M. ; Magistroni, R. ; Topaloglu, R. ; Bilginer, Y. ; D'Amico, M. ; Stangou, M. ; Giacchino, F. ; Goumenos, D. ; Kalliakmani, P. ; Gerolymos, M. ; Galesic, K. ; Geddes, C. ; Siamopoulos, K. ; Balafa, O. ; Galliani, M. ; Stratta, P. ; Quaglia, M. ; Bergia, R. ; Cravero, R. ; Salvadori, M. ; Cirami, L. ; Fellstrom, B. ; Kloster Smerud, H. ; Stellato, T. ; Egido, J. ; Martin, C. ; Floege, J. ; Eitner, F. ; Lupo, A. ; Bernich, P. ; Menè, P. ; Morosetti, M. ; Van Kooten, C. ; Rabelink, T. ; Reinders, M. E J ; Boria Grinyo, J. M. ; Cusinato, S. ; Benozzi, L. ; Savoldi, S. ; Licata, C. ; Mizerska Wasiak, M. ; Martina, G. ; Messuerotti, A. ; Dal Canton, A. ; Esposito, C. ; Migotto, C. ; Triolo, G. ; Mariano, F. ; Pozzi, C. ; Boero, R. ; Ferrario, F. ; Gutiérrez, E. ; Arce Terroba, J. ; Fortunato, M. ; Ozluk, Y. ; Kilicaslan, I. ; Steenberger, E. ; Soderberg, M. ; Da Costa Ferreira, A. C. ; Riispere, Z. ; Furci, L. ; Orhan, D. ; Kipgen, D. ; Casartelli, D. ; Galesic Ljubanovic, D. ; Bertoni, E. ; Cannata Ortiz, P. ; Groene, H. J. ; Stoppacciaro, A. ; Bajema, I. ; Bruijn, J. ; Fulladosa Oliveras, X. ; Maldyk, J. ; Ioachim, E. / Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. In: Kidney International. 2014 ; Vol. 86, No. 4. pp. 828-836.
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abstract = "The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86{\%} received renin-angiotensin system blockade and 42{\%} glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m 2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5{\%}). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy.",
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author = "Rosanna Coppo and St{\'e}phan Troyanov and Shubha Bellur and Daniel Cattran and Cook, {H. Terence} and John Feehally and Roberts, {Ian S D} and Laura Morando and Roberta Camilla and Vladimir Tesar and Sigrid Lunberg and Loreto Gesualdo and Francesco Emma and Cristiana Rollino and Alessandro Amore and Manuel Praga and Sandro Feriozzi and Giuseppe Segoloni and Antonello Pani and Giovanni Cancarini and Magalena Durlik and Elisabetta Moggia and Gianna Mazzucco and Costantinos Giannakakis and Eva Honsova and Sundelin, {B. Brigitta} and Palma, {Anna Maria Di} and Franco Ferrario and Eduardo Gutierrez and Asunis, {Anna Maria} and Jonathan Barratt and Regina Tardanico and Agnieszka Perkowska-Ptasinska and D. Maixnerova and S. Lundberg and L. Fuiano and G. Beltrame and L. Peruzzi and R. Polci and L. Colla and A. Angioi and D. Piras and S. Ravera and J. Ballarin and {Di Giulio}, S. and F. Pugliese and Y. Caliskan and F. Locatelli and {Del Vecchio}, L. and Wetzels, {J. F M} and H. Peters and U. Berg and F. Carvalho and M. Maggio and A. Wiecek and M. Ots-Rosenberg and R. Magistroni and R. Topaloglu and Y. Bilginer and M. D'Amico and M. Stangou and F. Giacchino and D. Goumenos and P. Kalliakmani and M. Gerolymos and K. Galesic and C. Geddes and K. Siamopoulos and O. Balafa and M. Galliani and P. Stratta and M. Quaglia and R. Bergia and R. Cravero and M. Salvadori and L. Cirami and B. Fellstrom and {Kloster Smerud}, H. and T. Stellato and J. Egido and C. Martin and J. Floege and F. Eitner and A. Lupo and P. Bernich and P. Men{\`e} and M. Morosetti and {Van Kooten}, C. and T. Rabelink and Reinders, {M. E J} and {Boria Grinyo}, {J. M.} and S. Cusinato and L. Benozzi and S. Savoldi and C. Licata and {Mizerska Wasiak}, M. and G. Martina and A. Messuerotti and {Dal Canton}, A. and C. Esposito and C. Migotto and G. Triolo and F. Mariano and C. Pozzi and R. Boero and F. Ferrario and E. Guti{\'e}rrez and {Arce Terroba}, J. and M. Fortunato and Y. Ozluk and I. Kilicaslan and E. Steenberger and M. Soderberg and {Da Costa Ferreira}, {A. C.} and Z. Riispere and L. Furci and D. Orhan and D. Kipgen and D. Casartelli and {Galesic Ljubanovic}, D. and E. Bertoni and {Cannata Ortiz}, P. and Groene, {H. J.} and A. Stoppacciaro and I. Bajema and J. Bruijn and {Fulladosa Oliveras}, X. and J. Maldyk and E. Ioachim",
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TY - JOUR

T1 - Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments

AU - Coppo, Rosanna

AU - Troyanov, Stéphan

AU - Bellur, Shubha

AU - Cattran, Daniel

AU - Cook, H. Terence

AU - Feehally, John

AU - Roberts, Ian S D

AU - Morando, Laura

AU - Camilla, Roberta

AU - Tesar, Vladimir

AU - Lunberg, Sigrid

AU - Gesualdo, Loreto

AU - Emma, Francesco

AU - Rollino, Cristiana

AU - Amore, Alessandro

AU - Praga, Manuel

AU - Feriozzi, Sandro

AU - Segoloni, Giuseppe

AU - Pani, Antonello

AU - Cancarini, Giovanni

AU - Durlik, Magalena

AU - Moggia, Elisabetta

AU - Mazzucco, Gianna

AU - Giannakakis, Costantinos

AU - Honsova, Eva

AU - Sundelin, B. Brigitta

AU - Palma, Anna Maria Di

AU - Ferrario, Franco

AU - Gutierrez, Eduardo

AU - Asunis, Anna Maria

AU - Barratt, Jonathan

AU - Tardanico, Regina

AU - Perkowska-Ptasinska, Agnieszka

AU - Maixnerova, D.

AU - Lundberg, S.

AU - Fuiano, L.

AU - Beltrame, G.

AU - Peruzzi, L.

AU - Polci, R.

AU - Colla, L.

AU - Angioi, A.

AU - Piras, D.

AU - Ravera, S.

AU - Ballarin, J.

AU - Di Giulio, S.

AU - Pugliese, F.

AU - Caliskan, Y.

AU - Locatelli, F.

AU - Del Vecchio, L.

AU - Wetzels, J. F M

AU - Peters, H.

AU - Berg, U.

AU - Carvalho, F.

AU - Maggio, M.

AU - Wiecek, A.

AU - Ots-Rosenberg, M.

AU - Magistroni, R.

AU - Topaloglu, R.

AU - Bilginer, Y.

AU - D'Amico, M.

AU - Stangou, M.

AU - Giacchino, F.

AU - Goumenos, D.

AU - Kalliakmani, P.

AU - Gerolymos, M.

AU - Galesic, K.

AU - Geddes, C.

AU - Siamopoulos, K.

AU - Balafa, O.

AU - Galliani, M.

AU - Stratta, P.

AU - Quaglia, M.

AU - Bergia, R.

AU - Cravero, R.

AU - Salvadori, M.

AU - Cirami, L.

AU - Fellstrom, B.

AU - Kloster Smerud, H.

AU - Stellato, T.

AU - Egido, J.

AU - Martin, C.

AU - Floege, J.

AU - Eitner, F.

AU - Lupo, A.

AU - Bernich, P.

AU - Menè, P.

AU - Morosetti, M.

AU - Van Kooten, C.

AU - Rabelink, T.

AU - Reinders, M. E J

AU - Boria Grinyo, J. M.

AU - Cusinato, S.

AU - Benozzi, L.

AU - Savoldi, S.

AU - Licata, C.

AU - Mizerska Wasiak, M.

AU - Martina, G.

AU - Messuerotti, A.

AU - Dal Canton, A.

AU - Esposito, C.

AU - Migotto, C.

AU - Triolo, G.

AU - Mariano, F.

AU - Pozzi, C.

AU - Boero, R.

AU - Ferrario, F.

AU - Gutiérrez, E.

AU - Arce Terroba, J.

AU - Fortunato, M.

AU - Ozluk, Y.

AU - Kilicaslan, I.

AU - Steenberger, E.

AU - Soderberg, M.

AU - Da Costa Ferreira, A. C.

AU - Riispere, Z.

AU - Furci, L.

AU - Orhan, D.

AU - Kipgen, D.

AU - Casartelli, D.

AU - Galesic Ljubanovic, D.

AU - Bertoni, E.

AU - Cannata Ortiz, P.

AU - Groene, H. J.

AU - Stoppacciaro, A.

AU - Bajema, I.

AU - Bruijn, J.

AU - Fulladosa Oliveras, X.

AU - Maldyk, J.

AU - Ioachim, E.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin-angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m 2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5%). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy.

AB - The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin-angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m 2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5%). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy.

KW - glomerular diseases

KW - IgA nephropathy

KW - progression of chronic renal failure

KW - proteinuria

KW - renal pathology

KW - risk factors

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