The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility
The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility
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DOI：
10.1038/ki.2009.168
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发表时间：
2009-09-01
影响因子：
19.6
通讯作者：
Zhang, Hong
中科院分区：
文献类型：
--
作者：
Roberts, Ian S. D.;Cook, H. Terence;Zhang, Hong
目前用于评估肾小球疾病的病理分类通常是基于意见的，并建立在肾脏病理学家关于历史上被认为与预后相关的病变的专家假设的基础上。在这里，我们开发了一种独特的方法来对一种肾小球疾病-IgA肾病进行病理分类，其中肾脏病理学家首先进行了广泛的迭代工作，以确定具有可接受的观察者间重复性的病理变量。在这些特征组密切相关的情况下，变量的选择是基于对抽样误差的敏感性最小和在日常实践中易于评分的基础上。这个过程确定了六个病理变量，然后可以用来询问预后意义，独立于IgA肾病的临床数据(在随附的文章中描述)。这些变量是(1)系膜细胞评分；(2)节段性硬化的肾小球百分比；(3)毛细血管内高细胞或(4)细胞/纤维细胞新月体；(5)间质纤维化/肾小管萎缩的百分比；(6)动脉硬化评分。观察者间个体病理特征的重复性结果可能适用于其他肾小球肾炎，但变量之间的相关性是否取决于特定类型的肾小球病理生物学尚不清楚。这项研究中确定的变量经受住了严格的病理学审查和统计检验，我们建议它们成为IgA肾病病理报告的必要组成部分。我们的方法，将强大的基于证据的数据集转换为工作格式，是开发其他类型肾脏疾病分类的模型。
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.