The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification
The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification
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DOI：
10.1038/ki.2009.243
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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：
Cattran, Daniel C.;Coppo, Rosanna;Zhang, Hong
IgA肾病是世界范围内最常见的肾小球疾病，但其病理和临床分类尚无国际共识。在这里，一个国际共识工作组提出了IgA肾病的新分类。这个新系统的目标是识别特定的病理特征，更准确地预测IgA肾病肾脏疾病进展的风险，从而使临床医生和病理学家能够改善个体患者的预后。在一项回顾性分析中，对265名成人和儿童IgA肾病患者进行了中位5年的随访，获得了序贯临床数据。所有患者的肾活检由不了解临床数据的病理学家进行评分，通过迭代过程确定可重复的病理变量。其中四个变量：(1)系膜高细胞性评分，(2)节段性肾小球硬化，(3)毛细血管内高细胞性，(4)小管萎缩/间质纤维化随后被证明在预测肾脏预后方面具有独立的价值。这些特定的病理特征经受住了严格的统计分析，即使在考虑了活检时以及随访期间所有可用的临床指标之后。这些特征具有预后意义，我们建议在预测预后时考虑到这些特征，而不是在出现和随访时的临床特征。由于在入组队列中月牙的患病率较低，因此未对月牙的价值进行研究。
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.