Skip to main content

Semiquantitative classification (SQC) and Oxford classifications predict poor renal outcome better than The International Study of Kidney Disease in Children (ISKDC) and Haas in patients with IgAV nephritis: a multicenter study

Journal of Nephrology volume 36, pages 441–449 (2023)Cite this article

A Correction to this article was published on 04 December 2022

This article has been updated

Abstract

Introduction

Several histologic classifications are used in the evaluation of IgA vasculitis nephritis (IgAVN), however, to date, no studies have determined which one has the strongest association with the severity of IgAVN and, as a consequence, its outcomes.

Materials and methods

Patients included in the study were diagnosed with IgAV and IgAVN in seven tertiary university medical centers in Croatia, Italy and Israel. The International Study of Kidney Disease in Children (ISKDC), Haas, Oxford, and Semiquantitative classification (SQC) classifications were used in the analysis and description of renal biopsy. Time from biopsy to outcome evaluation was a statistically significant factor in outcome prediction that was used to define the base model, and was a covariate in all the tested models.

Results

Sixty-seven patients were included in this study. The SQC classification proved to be the best one in outcome prediction, followed by the Oxford classification. The ISKDC and Haas classifications could not predict renal outcome. The Oxford parameters for mesangial hypercellularity and tubular atrophy, as well as the SQC parameters for cellular crescents showed an independent statistically significant contribution to outcome prediction. High level of twenty-four hour protein excretion was associated with a higher grade in the Oxford, SQC and ISKDC classifications. Endocapillary proliferation was positively associated with the Pediatric Vasculitis Activity Score (PVAS) at diagnosis, while tubular atrophy was negatively associated.

Conclusion

The SQC, followed by the Oxford classification were found to provide the best classifications of renal biopsy analysis in patients to predict the outcome in patients with IgAVN. Cellular crescents, mesangial hypercellularity and tubular atrophy showed significant contributions, indicating that active and chronic variables should be included in the estimation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Change history

References

  1. Jelusic M, Sestan M, Giani T, Cimaz R (2022) New insights and challenges associated with IgA vasculitis and IgA vasculitis with nephritis—is it time to change the paradigm of the most common systemic vasculitis in childhood? Front Pediatr 10:1–10. https://doi.org/10.3389/fped.2022.853724

    Article  Google Scholar 

  2. Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR (2002) Incidence of Henoch-Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 360:1197–1202. https://doi.org/10.1016/S0140-6736(02)11279-7

    Article  PubMed  Google Scholar 

  3. Sapina M, Frkovic M, Sestan M et al (2021) Geospatial clustering of childhood IgA vasculitis and IgA vasculitis-associated nephritis. Ann Rheum Dis 80:610–616. https://doi.org/10.1136/annrheumdis-2020-218649

    Article  CAS  PubMed  Google Scholar 

  4. Jelusic M, Sestan M, Cimaz R, Ozen S (2019) Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used? Pediatr Rheumatol 17:10. https://doi.org/10.1186/s12969-019-0311-z

    Article  Google Scholar 

  5. Sestan M, Srsen S, Kifer N et al (2022) Persistence and severity of cutaneous manifestations in IgA vasculitis is associated with development of IgA vasculitis nephritis in children. Dermatology 238:340–346. https://doi.org/10.1159/000516765

    Article  CAS  PubMed  Google Scholar 

  6. Counahan R, Winterborn MH, White RH et al (1977) Prognosis of Henoch-Schonlein nephritis in children. BMJ 2:11–14. https://doi.org/10.1136/bmj.2.6078.11

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Haas M (1997) Histologic subclassification of IgA nephropathy: a clinicopathologic study of 244 cases. Am J Kidney Dis 29:829–842. https://doi.org/10.1016/S0272-6386(97)90456-X

    Article  CAS  PubMed  Google Scholar 

  8. Cattran DC, Coppo R, Cook HT et al (2009) The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 76:534–545. https://doi.org/10.1038/ki.2009.243

    Article  PubMed  Google Scholar 

  9. Trimarchi H, Barratt J, Cattran DC et al (2017) Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification Working Group. Kidney Int 91:1014–1021. https://doi.org/10.1016/j.kint.2017.02.003

    Article  PubMed  Google Scholar 

  10. Koskela M, Ylinen E, Ukonmaanaho E-M et al (2017) The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch-Schönlein purpura nephritis. Pediatr Nephrol 32:1201–1209. https://doi.org/10.1007/s00467-017-3608-5

    Article  PubMed  Google Scholar 

  11. Ozen S, Marks SD, Brogan P et al (2019) European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis—the SHARE initiative. Rheumatology 58:1607–1616. https://doi.org/10.1093/rheumatology/kez041

    Article  CAS  PubMed  Google Scholar 

  12. Dolezalova P, Price-Kuehne FE, Özen S et al (2013) Disease activity assessment in childhood vasculitis: development and preliminary validation of the Paediatric Vasculitis Activity Score (PVAS). Ann Rheum Dis 72:1628–1633. https://doi.org/10.1136/annrheumdis-2012-202111

    Article  PubMed  Google Scholar 

  13. He M, Li C, Kang Y et al (2021) Clinical predictive model for the 1-year remission probability of IgA vasculitis nephritis. Int Immunopharmacol 101:108341. https://doi.org/10.1016/j.intimp.2021.108341

    Article  CAS  PubMed  Google Scholar 

  14. Ronkainen J, Nuutinen M, Koskimies O (2002) The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 360:666–670. https://doi.org/10.1016/S0140-6736(02)09835-5

    Article  PubMed  Google Scholar 

  15. Clavé S, Sordet M, Tsimaratos M et al (2021) Association of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis. Eur J Pediatr 180:3209–3218. https://doi.org/10.1007/s00431-021-04065-4

    Article  CAS  PubMed  Google Scholar 

  16. Delbet J-D, Geslain G, Auger M et al (2020) Histological prognostic factors in children with Henoch-Schönlein purpura nephritis. Pediatr Nephrol 35:313–320. https://doi.org/10.1007/s00467-019-04363-y

    Article  PubMed  Google Scholar 

  17. Wang M, Wang R, He X et al (2021) Using MEST-C Scores and the International Study of Kidney Disease in Children Classification to Predict Outcomes of Henoch-Schönlein Purpura Nephritis in Children. Front Pediatr 9:1–9. https://doi.org/10.3389/fped.2021.658845

    Article  Google Scholar 

  18. Luo X, Tan J, Wan D et al (2022) Predictability of the Oxford classification of IgA nephropathy in Henoch-Schonlein purpura nephritis. Int Urol Nephrol 54:99–109. https://doi.org/10.1007/s11255-021-02861-3

    Article  CAS  PubMed  Google Scholar 

  19. Coppo R, D’Arrigo G, Tripepi G et al (2020) Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant 35:1002–1009. https://doi.org/10.1093/ndt/gfy302

    Article  CAS  PubMed  Google Scholar 

  20. Yun D, Kim DK, Oh K-H et al (2020) MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis. BMC Nephrol 21:33. https://doi.org/10.1186/s12882-020-1691-5

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Huang X, Ma L, Ren P et al (2019) Updated Oxford classification and the international study of kidney disease in children classification: application in predicting outcome of Henoch-Schönlein purpura nephritis. Diagn Pathol 14:40. https://doi.org/10.1186/s13000-019-0818-0

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yel S, Dursun I, Pinarbaşi AS et al (2020) Patient outcomes of Henoch-Schönlein purpura nephritis according to the new semiquantitative classification. Fetal Pediatr Pathol 39:381–389. https://doi.org/10.1080/15513815.2019.1658245

    Article  PubMed  Google Scholar 

  23. Koskela M, Ylinen E, Autio-Harmainen H et al (2020) Prediction of renal outcome in Henoch-Schönlein nephritis based on biopsy findings. Pediatr Nephrol 35:659–668. https://doi.org/10.1007/s00467-019-04415-3

    Article  PubMed  Google Scholar 

  24. Huang X, Wu J, Wu X et al (2018) Significance of histological crescent formation in patients with IgA vasculitis (Henoch-Schönlein purpura)-related nephritis: a cohort in the adult Chinese population. BMC Nephrol 19:334. https://doi.org/10.1186/s12882-018-1117-9

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Peruzzi L, Coppo R (2021) IgA vasculitis nephritis in children and adults: one or different entities? Pediatr Nephrol 36:2615–2625. https://doi.org/10.1007/s00467-020-04818-7

    Article  PubMed  Google Scholar 

  26. Coppo R, Andrulli S, Amore A et al (2006) Predictors of outcome in Henoch-Schönlein Nephritis in Children and Adults. Am J Kidney Dis 47:993–1003. https://doi.org/10.1053/j.ajkd.2006.02.178

    Article  PubMed  Google Scholar 

  27. Roberts ISD, Cook HT, Troyanov S et al (2009) The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 76:546–556. https://doi.org/10.1038/ki.2009.168

    Article  PubMed  Google Scholar 

  28. Ye Q, Shang S, Liu A et al (2015) 24h urinary protein levels and urine protein/creatinine ratios could probably forecast the pathological classification of HSPN. PLoS One 10:e0127767. https://doi.org/10.1371/journal.pone.0127767

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Mizerska-Wasiak M, Turczyn A, Cichoń-Kawa K et al (2021) IgA vasculitis nephritis clinical course and kidney biopsy—national study in children. Pediatr Rheumatol 19:150. https://doi.org/10.1186/s12969-021-00616-z

    Article  Google Scholar 

  30. Shi D, Chan H, Yang X et al (2019) Risk factors associated with IgA vasculitis with nephritis (Henoch–Schönlein purpura nephritis) progressing to unfavorable outcomes: a meta-analysis. PLoS One 14:e0223218. https://doi.org/10.1371/journal.pone.0223218

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Coppo R, Troyanov S, Bellur S et al (2014) Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney Int 86:828–836. https://doi.org/10.1038/ki.2014.63

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Funding

Funding was provided by the Croatian Science Foundation  (IP-2019-04-8822).

Author information

Authors and Affiliations

  1. Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Nastasia Kifer, Mario Sestan, Martina Held, Marijan Frković & Marija Jelusic

  2. Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Stela Bulimbasic & Marijana Coric

  3. Department of Biophysics, University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia

    Domagoj Kifer

  4. Division of Rheumatology and Immunology, Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia

    Sasa Srsen

  5. Department of Internal Medicine, Clinical Hospital Holly Spirit, University of Zagreb School of Medicine, Zagreb, Croatia

    Ana Gudelj Gracanin

  6. Pediatric Rheumatology Service, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

    Merav Heshin-Bekenstein

  7. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Teresa Giani & Rolando Cimaz

  8. ASST Pini-CTO, Milan, Italy

    Rolando Cimaz

  9. Children’s Hospital Zagreb, University of Osijek, Medical Faculty Osijek, Osijek, Croatia

    Alenka Gagro

Authors
  1. Nastasia Kifer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stela Bulimbasic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Sestan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martina Held
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Domagoj Kifer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sasa Srsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ana Gudelj Gracanin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Merav Heshin-Bekenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Teresa Giani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Rolando Cimaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alenka Gagro
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marijan Frković
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Marijana Coric
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Marija Jelusic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marija Jelusic.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original article has been updated: Due to title update.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kifer, N., Bulimbasic, S., Sestan, M. et al. Semiquantitative classification (SQC) and Oxford classifications predict poor renal outcome better than The International Study of Kidney Disease in Children (ISKDC) and Haas in patients with IgAV nephritis: a multicenter study. J Nephrol 36, 441–449 (2023). https://doi.org/10.1007/s40620-022-01509-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-022-01509-4

Keywords

  • IgA vasculitis
  • Henoch-Schonlein purpura
  • Nephritis
  • Pathology