Glomerular disease: Updated Oxford Classification of IgA nephropathy: a new MEST-C score

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

The Oxford Classification of IgA nephropathy (IgAN) is the most widely accepted system for assessing histologic findings in IgAN. A new publication refines this classification by adding a crescent score, reassessing the segmental sclerosis score, and contextualizing the clinical relevance of the histologic lesions.

Related collections

Most cited references 6

Record: found
Abstract: found
Article: not found

A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy

Mark Haas, Jacobien Verhave, Zhi-Hong Liu … (2017)

The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a ≥50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean±SD eGFR of 78±29 ml/min per 1.73 m2 and median (interquartile range) proteinuria of 1.2 (0.7-2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression. We propose adding the following crescent scores to the Oxford Classification: C0 (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in one fourth or more of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.

0 comments Cited 114 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The MEST score provides earlier risk prediction in lgA nephropathy.

Sean Barbour, Gabriela Espino-Hernandez, Heather N. Reich … (2016)

The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.

0 comments Cited 102 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Evaluation of the Oxford Classification of IgA nephropathy: a systematic review and meta-analysis.

Stéphan Troyanov, D. Xu, Sufang Shi … (2013)

The Oxford Classification of the pathology of immunoglobulin A (IgA) nephropathy, developed in 2009, is highly predictive of renal prognosis. It has been validated in different populations, but the results remain inconsistent. Systematic review and meta-analysis. Patients with biopsy-proven primary IgA nephropathy. Studies assessing the Oxford Classification of IgA nephropathy published between January 2009 and December 2012 were included following systematic searching of the MEDLINE and EMBASE databases. 4 pathologic lesions of the Oxford Classification: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T). Kidney failure defined as doubled serum creatinine level, 50% decline in estimated glomerular filtration rate, or end-stage kidney disease. 16 retrospective cohort studies with 3,893 patients and 570 kidney failure events were included. In a multivariate model, HRs for kidney failure were 0.6 (95% CI, 0.5-0.8; P 25% tubular atrophy/interstitial fibrosis), respectively, without evidence of heterogeneity. Pooled results showed that E lesions were not associated with kidney failure (HR, 1.4; 95% CI, 0.9-2.0; P = 0.1), with evidence of heterogeneity (I(2) = 54.1%; P = 0.01). Crescent (C) lesions were associated with kidney failure (HR, 2.3; 95% CI, 1.6-3.4; P < 0.001), with no evidence of heterogeneity (I(2) = 14.7%; P = 0.3). All studies were retrospective. This was not an individual-patient-data meta-analysis. This study suggests that M, S, T, and C lesions, but not E lesions, are associated strongly with progression to kidney failure and thus should be included in the Oxford Classification system. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

0 comments Cited 72 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Title: Nature Reviews Nephrology

Abbreviated Title: Nat Rev Nephrol

Publisher: Springer Nature

ISSN (Print): 1759-5061

ISSN (Electronic): 1759-507X

Publication date Created: May 22 2017

Publication date (Print): May 22 2017

Volume:

Issue:

Article

DOI: 10.1038/nrneph.2017.67

PubMed ID: 28529339

SO-VID: 4ad9e88a-e77c-4f53-9f61-cfddd1fa6f69

History

Data availability:

Comments

Comment on this article

scite_

Cited by 20

See all cited by

Most referenced authors 427

See all reference authors

Glomerular disease: Updated Oxford Classification of IgA nephropathy: a new MEST-C score

Read this article at

Abstract

Related collections

Alternative approaches to Alzheimer's Disease

Most cited references 6

A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy

The MEST score provides earlier risk prediction in lgA nephropathy.

Evaluation of the Oxford Classification of IgA nephropathy: a systematic review and meta-analysis.

Author and article information

Journal

Article

History

Comments

Comment on this article

Similar content 129

Cited by 20

Most referenced authors 427