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Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schonlein purpura nephritis in adults

 Chan Ho Kim  ;  Beom Jin Lim  ;  Yoon Sung Bae  ;  Young Eun Kwon  ;  Yung Ly Kim  ;  Ki Heon Nam  ;  Kyoung Sook Park  ;  Seong Yeong An  ;  Hyang Mo Koo  ;  Fa Mee Doh  ;  Mi Jung Lee  ;  Hyung Jung Oh  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Hyun Joo Jeong  ;  Seung Hyeok Han 
 Modern Pathology, Vol.27(7) : 972-982, 2014 
Journal Title
 Modern Pathology 
Issue Date
Recently, there has been emerging concern that crescents, the main histologic feature of Henoch–Schönlein purpura nephritis, merely reflect active inflammation, and may not be useful in predicting long-term outcomes. We therefore conducted a single-center retrospective study to evaluate whether the new Oxford classification of immunoglobulin A nephropathy can be used to predict long-term outcome in patients with Henoch–Schönlein purpura nephritis. We included 61 biopsy-proven patients with Henoch–Schönlein purpura nephritis between January 1991 and August 2010. In addition to the International Study of Kidney Disease in Children classification, pathologic findings were also evaluated by the Oxford classification. Primary outcomes were defined as either the onset of estimated glomerular filtration rate <60 ml/min per 1.73 m2 with ≥30% decrease in estimated glomerular filtration rate from baseline or end-stage renal disease. During a median follow-up of 49.3 months, 13 (21%) patients reached the primary end point. A Kaplan–Meier plot showed that renal event-free survival was significantly longer in patients with <50% crescents than in those with crescents in ≥50% of glomeruli (P=0.003). Among the components of the Oxford classification, patients with endocapillary hypercellularity (E1; P=0.016) and tubular atrophy/interstitial fibrosis (T1/T2; P=0.018) had lower renal survival rates than those with E0 and T0. In a multivariate Cox model adjusted for clinical and pathologic factors, E1 (hazard ratio=8.91; 95% confidence interval=1.47–53.88; P=0.017) and T1/T2 (hazard ratio=8.74; 95% confidence interval=1.40–54.38; P=0.020) were independently associated with reaching a primary outcome, whereas the extent of crescentic lesions was not. Our findings suggest that the Oxford classification can be used in predicting long-term outcomes of Henoch–Schönlein purpura nephritis.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
구향모(Koo, Hyang Mo)
권영은(Kwon, Young Eun)
김영리(Kim, Yung Ly)
김찬호(Kim, Chan Ho)
남기헌(Nam, Ki Heon) ORCID logo https://orcid.org/0000-0001-7312-7027
도화미(Doh, Fa Mee) ORCID logo https://orcid.org/0000-0002-4780-6728
박경숙(Park, Kyoung Sook)
안성영(An, Seong Yeong)
오형중(Oh, Hyung Jung)
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
이미정(Lee, Mi Jung)
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
최규헌(Choi, Kyu Hun) ORCID logo https://orcid.org/0000-0003-0095-9011
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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