Renal histopathology
E. J. Kim, J. H. Han, H. M. Koo, F. M. Doh, C. H. Kim, K. I. Ko, M. J. Lee, H. J. Oh, T.-H. Yoo, S.-W. Kang, K. H. Choi, S. H. Han
(+81 others)
2013
Nephrology, Dialysis and Transplantation
Introduction and Aims: Henoch-Schönlein purpura nephritis (HSPN) and immunoglobulin A nephropathy (IgAN) are considered to be a spectrum of one disease, and are indistinguishable immunohistopathologically. Recently, there has been emerging concern that crescents, the main histologic feature of HSPN, merely reflect active inflammation, thus may not useful in predicting long-term outcomes. Therefore we retrospectively evaluated whether the new Oxford classification of IgAN can be used to predict
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... ong-term outcome in adult HSPN patients. Methods: We included 61 biopsy-proven HSPN patients between January 1991 and August 2010 at our institution. Pathologic findings were evaluated both by the International Study of Kidney Disease in Children classification and the Oxford classification. Primary outcome was defined as either a decrease of ≥ 30% in estimated glomerular filtration rate or progression to the end-stage renal disease. Results: During a median follow-up of 49.3 months, 13 (21.3%) patients reached the primary endpoint. 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 (HR 8.91; 95% CI 1.47 to 53.88; P = 0.017) and T1/T2 (HR 8.74; 95% CI 1.40 to 54.38; P = 0.020) were independently associated with reaching a primary outcome, whereas the extent of crescentic lesions was not. Conclusions: Our findings suggest that the Oxford classification can be used in predicting long-term outcomes of HSPN. A larger multicenter study with a longer follow-up is warranted to clarify the predictive value of pathologic features of the Oxford classification in the HSPN.
doi:10.1093/ndt/gft115
fatcat:tdbz4gseljgulhwppthgjquboy
