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Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group.

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journal contribution
posted on 21.08.2017, 11:15 by Hernán Trimarchi, Jonathan Barratt, Daniel C. Cattran, H. Terence Cook, Rosanna Coppo, Mark Haas, Zhi-Hong Liu, Ian S. D. Roberts, Yukio Yuzawa, Hong Zhang, John Feehally, IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society
Since the Oxford Classification of IgA nephropathy (IgAN) was published in 2009, MEST scores have been increasingly used in clinical practice. Further retrospective cohort studies have confirmed that in biopsy specimens with a minimum of 8 glomeruli, mesangial hypercellularity (M), segmental sclerosis (S), and interstitial fibrosis/tubular atrophy (T) lesions predict clinical outcome. In a larger, more broadly based cohort than in the original Oxford study, crescents (C) are predictive of outcome, and we now recommend that C be added to the MEST score, and biopsy reporting should provide a MEST-C score. Inconsistencies in the reporting of M and endocapillary cellularity (E) lesions have been reported, so a web-based educational tool to assist pathologists has been developed. A large study showed E lesions are predictive of outcome in children and adults, but only in those without immunosuppression. A review of S lesions suggests there may be clinical utility in the subclassification of segmental sclerosis, identifying those cases with evidence of podocyte damage. It has now been shown that combining the MEST score with clinical data at biopsy provides the same predictive power as monitoring clinical data for 2 years; this requires further evaluation to assess earlier effective treatment intervention. The IgAN Classification Working Group has established a well-characterized dataset from a large cohort of adults and children with IgAN that will provide a substrate for further studies to refine risk prediction and clinical utility, including the MEST-C score and other factors.

History

Citation

Kidney International, 2017, 91 (5), pp. 1014-1021

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Infection, Immunity and Inflammation

Version

AM (Accepted Manuscript)

Published in

Kidney International

Publisher

Elsevier for International Society of Nephrology

issn

0085-2538

eissn

1523-1755

Acceptance date

02/02/2017

Copyright date

2017

Available date

22/03/2018

Publisher version

http://www.sciencedirect.com/science/article/pii/S0085253817301011?via=ihub

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en