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

Authors
 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 
Citation
 ANNALS OF MEDICINE, Vol.49(3) : 217-229, 2017 
Journal Title
ANNALS OF MEDICINE
ISSN
 0785-3890 
Issue Date
2017
MeSH
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
Keywords
IgA nephropathy ; Oxford classification ; glucocorticoid treatment ; proteinuria
Abstract
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.
Full Text
http://www.tandfonline.com/doi/full/10.1080/07853890.2016.1252058
DOI
10.1080/07853890.2016.1252058
Appears in Collections:
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
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kwon, Young Eun(권영은)
Kee, Youn Kyung(기연경)
Kim, Hyoung Rae(김형래)
Park, Seo Hyun(박서현)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lim, Beom Jin(임범진) ORCID logo https://orcid.org/0000-0003-2856-0133
Jung, Su Young(정수영)
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
Jhee, Jong Hyun(지종현)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154484
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