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Clinical usefulness of the Oxford classification in determining immunosuppressive treatment in IgA nephropathy

 Chang-Yun Yoon  ;  Tae Ik Chang  ;  Ea Wha Kang  ;  Beom Jin Lim  ;  Jeong Hae Kie  ;  Youn Kyung Kee  ;  Hyoungnae Kim  ;  Seohyun Park  ;  Hae-Ryong Yun  ;  Su-Young Jung  ;  Jong Hyun Jhee  ;  Young Eun Kwon  ;  Hyung Jung Oh  ;  Jung Tak Park  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Hyeon Joo Jeong  ;  Seung Hyeok Han 
 Annals of Medicine, Vol.49(3) : 217-229, 2017 
Journal Title
 Annals of Medicine 
Issue Date
Adult ; Biomarkers/metabolism ; Clinical Decision-Making ; Clinical Trials as Topic ; Disease Progression ; Female ; Glomerular Filtration Rate/drug effects ; Glomerulonephritis, IGA/classification ; Glomerulonephritis, IGA/complications* ; Glomerulonephritis, IGA/drug therapy* ; Glomerulonephritis, IGA/pathology ; Glucocorticoids/therapeutic use ; Humans ; Immunosuppressive Agents/therapeutic use* ; Kidney/drug effects ; Kidney/pathology ; Male ; Middle Aged ; Predictive Value of Tests ; Proteinuria/complications ; Proteinuria/drug therapy* ; Proteinuria/urine ; Renal Insufficiency/complications ; Renal Insufficiency/prevention & control
IgA nephropathy ; Oxford classification ; glucocorticoid treatment ; proteinuria
BACKGROUND: The Oxford classification has been widely used in IgA nephropathy. However, its clinical usefulness of determining immunosuppression is unknown. AIM: Whether the Oxford classification could predict the development of proteinuria ≥1 g/g Cr and worsening kidney function, as well as the clinical efficacy of corticosteroid treatment according to each histologic variable of the Oxford-MEST. METHODS: We included 377 patients with early-stage IgA nephropathy. The study endpoints were the development of a heavy proteinuria and a decline renal function. RESULTS: The results showed that among the Oxford-MEST lesions, only M1 predicted the risk of the development of proteinuria ≥1.0 g/g Cr compared to other lesions in a time-varying Cox model adjusted for multiple confounding factors. In addition, the risk of reaching a 30% decline in eGFR was significantly higher in patients with M1 than in those with M0. Furthermore, patients with M1 had a greater decline of eGFR than patients with M0. However, steroid treatment in M1 lesion was not associated with improving clinical outcomes in the unmatched and propensity score matched cohort. CONCLUSIONS: This finding may provide a rationale for using the Oxford classification as a guidance to initiate immunosuppression in the early stages of IgA nephropathy. KEY MESSAGES M1 has independently predictive role among the Oxford lesions in IgA nephropathy. Oxford classification should be defined during pathologic approach. Decision of starting immunosuppression according to the Oxford lesions.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
권영은(Kwon, Young Eun)
기연경(Kee, Youn Kyung)
김형래(Kim, Hyoung Rae)
박서현(Park, Seo Hyun)
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
윤창연(Yoon, Chang Yun)
윤해룡(Yun, Hae Ryong) ORCID logo https://orcid.org/0000-0002-7038-0251
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
정수영(Jung, Su Young)
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
지종현(Jhee, Jong Hyun)
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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