Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein 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, TaeHyun Yoo, Shin-Wook Kang, Kyu Hun Choi, Hyun Joo Jeong, SeungHyeok Han

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Abstract

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 m 2 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.

Original languageEnglish
Pages (from-to)972-982
Number of pages11
JournalModern Pathology
Volume27
Issue number7
DOIs
Publication statusPublished - 2014 Jan 1

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Schoenlein-Henoch Purpura
Nephritis
Immunoglobulin A
Glomerular Filtration Rate
IGA Glomerulonephritis
Confidence Intervals
Kidney
Kidney Diseases
Proportional Hazards Models
Disease-Free Survival
Chronic Kidney Failure
Atrophy
Fibrosis
Survival Rate
Retrospective Studies
Inflammation
Biopsy

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine

Cite this

Ho Kim, Chan ; Jin Lim, Beom ; Sung Bae, Yoon ; Eun Kwon, Young ; Ly Kim, Yung ; Heon Nam, Ki ; Sook Park, Kyoung ; Yeong An, Seong ; Mo Koo, Hyang ; Mee Doh, Fa ; Jung Lee, Mi ; Jung Oh, Hyung ; Yoo, TaeHyun ; Kang, Shin-Wook ; Hun Choi, Kyu ; Joo Jeong, Hyun ; Han, SeungHyeok. / Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein purpura nephritis in adults. In: Modern Pathology. 2014 ; Vol. 27, No. 7. pp. 972-982.
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abstract = "Recently, there has been emerging concern that crescents, the main histologic feature of Henoch-Sch{\"o}nlein 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-Sch{\"o}nlein purpura nephritis. We included 61 biopsy-proven patients with Henoch-Sch{\"o}nlein 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 m 2 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-Sch{\"o}nlein purpura nephritis.",
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Ho Kim, C, Jin Lim, B, Sung Bae, Y, Eun Kwon, Y, Ly Kim, Y, Heon Nam, K, Sook Park, K, Yeong An, S, Mo Koo, H, Mee Doh, F, Jung Lee, M, Jung Oh, H, Yoo, T, Kang, S-W, Hun Choi, K, Joo Jeong, H & Han, S 2014, 'Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein purpura nephritis in adults', Modern Pathology, vol. 27, no. 7, pp. 972-982. https://doi.org/10.1038/modpathol.2013.222

Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein purpura nephritis in adults. / Ho Kim, Chan; Jin Lim, Beom; Sung Bae, Yoon; Eun Kwon, Young; Ly Kim, Yung; Heon Nam, Ki; Sook Park, Kyoung; Yeong An, Seong; Mo Koo, Hyang; Mee Doh, Fa; Jung Lee, Mi; Jung Oh, Hyung; Yoo, TaeHyun; Kang, Shin-Wook; Hun Choi, Kyu; Joo Jeong, Hyun; Han, SeungHyeok.

In: Modern Pathology, Vol. 27, No. 7, 01.01.2014, p. 972-982.

Research output: Contribution to journalArticle

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AU - Ho Kim, Chan

AU - Jin Lim, Beom

AU - Sung Bae, Yoon

AU - Eun Kwon, Young

AU - Ly Kim, Yung

AU - Heon Nam, Ki

AU - Sook Park, Kyoung

AU - Yeong An, Seong

AU - Mo Koo, Hyang

AU - Mee Doh, Fa

AU - Jung Lee, Mi

AU - Jung Oh, Hyung

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

AU - Hun Choi, Kyu

AU - Joo Jeong, Hyun

AU - Han, SeungHyeok

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N2 - 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 m 2 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.

AB - 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 m 2 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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