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Pediatric Nephrology

, Volume 27, Issue 5, pp 783–792 | Cite as

Validity of the Oxford classification of IgA nephropathy in children

  • Yuko Shima
  • Koichi NakanishiEmail author
  • Taketsugu Hama
  • Hironobu Mukaiyama
  • Hiroko Togawa
  • Yuya Hashimura
  • Hiroshi Kaito
  • Mayumi Sako
  • Kazumoto Iijima
  • Norishige Yoshikawa
Original Article

Abstract

Background

In 2009, the Oxford classification of IgA nephropathy was published. However, its validity has not been fully examined in children. This study aimed to assess this system in an independent large-scale cohort of children.

Methods

We analyzed 161 consecutive children with newly diagnosed IgA nephropathy from 1977 to 1989 retrospectively. We examined the ability of each variable in the Oxford classification as a predictor of renal outcome defined as ≥ stage III chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2) using Cox regression analysis.

Results

The mean mesangial score, and ratios of segmental glomerulosclerosis, endocapillary hypercellularity, tubular atrophy, and crescents were 0.49, 0.8%, 13.1%, 3.3%, and 9.2% respectively. Seven cases reached ≥ stage III CKD. In univariate analyses, mesangial hypercellularity score, endocapillary hypercellularity, tubular atrophy, and crescents were significant predictors of renal outcome. In a multivariate analysis, only mesangial hypercellularity score, tubular atrophy, and crescents were significant though, depending on models. Segmental glomerulosclerosis was not a significant predictor of renal outcome. Although the significance of crescents was not addressed in the Oxford classification, crescents were important predictors of outcome.

Conclusions

The Oxford classification appears to be valid for predicting renal outcome in children.

Keywords

Crescents Endocapillary hypercellularity Cox gression Renal failure Segmental glomerulosclerosis Tubular atrophy 

Notes

Acknowledgements

The authors thank all participants and attending physicians for their contributions.

References

  1. 1.
    Donadio JV, Grande JP (2002) IgA nephropathy. N Engl J Med 347:738–748PubMedCrossRefGoogle Scholar
  2. 2.
    Alexopoulos E (2004) Treatment of primary IgA nephropathy. Kidney Int 65:341–355PubMedCrossRefGoogle Scholar
  3. 3.
    Appel GB, Waldman M (2006) The IgA nephropathy treatment dilemma. Kidney Int 69:1939–1944PubMedCrossRefGoogle Scholar
  4. 4.
    Yoshikawa N, Tanaka R, Iijima K (2001) Pathophysiology and treatment of IgA nephropathy in children. Pediatr Nephrol 16:446–457PubMedCrossRefGoogle Scholar
  5. 5.
    Yoshikawa N, Ito H, Nakamura H (1992) Prognostic indicators in childhood IgA nephropathy. Nephron 60:60–67PubMedCrossRefGoogle Scholar
  6. 6.
    Barratt J, Feehally J (2006) Treatment of IgA nephropathy. Kidney Int 69:1934–1938PubMedCrossRefGoogle Scholar
  7. 7.
    Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Cattran DC, Coppo R, Cook HT, Feehally J, Roberts IS, Troyanov S, Alpers CE, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn JA, D’Agati V, D’Amico G, Emancipator S, Emma F, Ferrario F, Fervenza FC, Florquin S, Fogo A, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hogg RJ, Hsu SI, Jennette JC, Joh K, Julian BA, Kawamura T, Lai FM, Leung CB, Li LS, Li PK, Liu ZH, Mackinnon B, Mezzano S, Schena FP, Tomino Y, Walker PD, Wang H, Weening JJ, Yoshikawa N, Zhang H (2009) The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 76:534–545PubMedCrossRefGoogle Scholar
  8. 8.
    Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn JA, Cattran DC, Coppo R, D’Agati V, D’Amico G, Emancipator S, Emma F, Feehally J, Ferrario F, Fervenza FC, Florquin S, Fogo A, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hogg RJ, Hsu SI, Jennette JC, Joh K, Julian BA, Kawamura T, Lai FM, Li LS, Li PK, Liu ZH, Mackinnon B, Mezzano S, Schena FP, Tomino Y, Walker PD, Wang H, Weening JJ, Yoshikawa N, Zhang H (2009) The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 76:546–556PubMedCrossRefGoogle Scholar
  9. 9.
    Coppo R, Troyanov S, Camilla R, Hogg RJ, Cattran DC, Cook HT, Feehally J, Roberts IS, Amore A, Alpers CE, Barratt J, Berthoux F, Bonsib S, Bruijn JA, D’Agati V, D’Amico G, Emancipator SN, Emma F, Ferrario F, Fervenza FC, Florquin S, Fogo AB, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hsu SI, Jennette JC, Joh K, Julian BA, Kawamura T, Lai FM, Li LS, Li PK, Liu ZH, Mezzano S, Schena FP, Tomino Y, Walker PD, Wang H, Weening JJ, Yoshikawa N, Zhang H (2010) The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults. Kidney Int 77:921–927PubMedCrossRefGoogle Scholar
  10. 10.
    Yata N, Nakanishi K, Shima Y, Togawa H, Obana M, Sako M, Nozu K, Tanaka R, Iijima K, Yoshikawa N (2008) Improved renal survival in Japanese children with IgA nephropathy. Pediatr Nephrol 23:905–912PubMedCrossRefGoogle Scholar
  11. 11.
    Kamei K, Nakanishi K, Ito S, Saito M, Sako M, Ishikura K, Hataya H, Honda M, Iijima K, Yoshikawa N, for the Japanese Pediatric IgA Nephropathy Treatment Study Group (2011) Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol 6:1301–1307PubMedCrossRefGoogle Scholar
  12. 12.
    Nakanishi K, Iijima K, Ishikura K, Hataya H, Awazu M, Sako M, Honda M, Yoshikawa N, The Japanese Pediatric IgA Nephropathy Treatment Study Group (2009) Efficacy and safety of lisinopril for mild childhood IgA nephropathy: a pilot study. Pediatr Nephrol 24:845–849PubMedCrossRefGoogle Scholar
  13. 13.
    Yoshikawa N, Ito H (1999) Combined therapy with prednisolone, azathioprine, heparin-warfarin, and dipyridamole for paediatric patients with severe IgA nephropathy—is it relevant for adult patients? Nephrol Dial Transplant 14:1097–1099PubMedCrossRefGoogle Scholar
  14. 14.
    Japanese Pediatric IgA Nephropathy Treatment Group (1999) A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. J Am Soc Nephrol 10:101–109Google Scholar
  15. 15.
    Yoshikawa N, Honda M, Iijima K, Awazu M, Hattori S, Nakanishi K, Ito H (2006) Steroid treatment for severe childhood IgA nephropathy: a randomized controlled trial. Clin J Am Soc Nephrol 1:511–517PubMedCrossRefGoogle Scholar
  16. 16.
    Yoshikawa N, Nakanishi K, Ishikura K, Hataya H, Iijima K, Honda M, Japanese Pediatric IgA Nephropathy Treatment Study Group (2008) Combination therapy with mizoribine for severe childhood IgA nephropathy: a pilot study. Pediatr Nephrol 23:757–763PubMedCrossRefGoogle Scholar
  17. 17.
    Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMedGoogle Scholar
  18. 18.
    Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS; National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMedCrossRefGoogle Scholar
  19. 19.
    Herzenberg AM, Fogo AB, Reich HN, Troyanov S, Bavbek N, Massat AE, Hunley TE, Hladunewich MA, Julian BA, Fervenza FC, Cattran DC (2011) Validation of the Oxford classification of IgA nephropathy. Kidney Int 80:310–317PubMedCrossRefGoogle Scholar
  20. 20.
    Edström Halling S, Söderberg MP, Berg UB (2011) Predictors of outcome in paediatric IgA nephropathy with regard to clinical and histopathological variables (Oxford classification). Nephrol Dial Transplant. doi: 10.1093/ndt/gfr339 PubMedGoogle Scholar

Copyright information

© IPNA 2011

Authors and Affiliations

  • Yuko Shima
    • 1
  • Koichi Nakanishi
    • 1
    Email author
  • Taketsugu Hama
    • 1
  • Hironobu Mukaiyama
    • 1
  • Hiroko Togawa
    • 1
  • Yuya Hashimura
    • 2
  • Hiroshi Kaito
    • 2
  • Mayumi Sako
    • 3
  • Kazumoto Iijima
    • 2
  • Norishige Yoshikawa
    • 1
  1. 1.Department of PediatricsWakayama Medical UniversityKimiidera, Wakayama CityJapan
  2. 2.Department of PediatricsKobe University Graduate School of MedicineKobeJapan
  3. 3.Division for Clinical TrialsNational Center for Child Health and DevelopmentSetagaya, TokyoJapan

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