title: Validation of the Oxford classification of IgA nephropathy for pediatric patients from China.
abstract: BACKGROUND
  The Oxford classification of IgA nephropathy (IgAN) provides a useful tool for prediction of renal prognosis. However, the application of this classification in children with IgAN needs validation in different patient populations.
  
  
  METHODS
  A total of 218 children with IgAN from 7 renal centers in China were enrolled. The inclusion criteria was similar to the original Oxford study.
  
  
  RESULTS
  There were 98 patients (45%) with mesangial proliferation (M1), 51 patients (23%) with endocapillary proliferation (E1), 136 patients (62%) with segmental sclerosis/adhesion lesion (S1), 13 patients (6%) with moderate tubulointerstitial fibrosis (T1 26-50% of cortex scarred), and only 2 patients (1%) with severe tubulointerstitial fibrosis (T2, >50% of cortex scarred). During a median follow-up duration of 56 months, 24 children (12.4%) developed ESRD or 50% decline in renal function. In univariate COX analysis, we found that tubular atrophy/interstitial fibrosis (HR 4.3, 95%CI 1.8-10.5, P < 0.001) and segmental glomerulosclerosis (HR 9.2 1.2-68.6, P = 0.03) were significant predictors of renal outcome. However, mesangial hypercellularity, endocapillary proliferation, crescents, and necrosis were not associated with renal prognosis. In the multivariate COX regression model, none of these pathologic lesions were shown to be independent risk factors of unfavorable renal outcome except for tubular atrophy/interstitial fibrosis (HR 2.9, 95%CI 1.0-7.9 P = 0.04).
  
  
  CONCLUSIONS
  We confirmed tubular atrophy/interstitial fibrosis was the only feature independently associated with renal outcomes in Chinese children with IgAN.
authors.affiliation: Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Weibo
authors.initials: W
authors.lastname: Le
authors.forename: Cai-Hong
authors.initials: CH
authors.lastname: Zeng
authors.forename: Zhangsuo
authors.initials: Z
authors.lastname: Liu
authors.forename: Dong
authors.initials: D
authors.lastname: Liu
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.forename: Rui-Xia
authors.initials: RX
authors.lastname: Lin
authors.forename: Zheng-Kun
authors.initials: ZK
authors.lastname: Xia
authors.forename: Zhong-Min
authors.initials: ZM
authors.lastname: Fan
authors.forename: Guanghua
authors.initials: G
authors.lastname: Zhu
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Yihui
authors.initials: Y
authors.lastname: Zhai
authors.forename: Ying
authors.initials: Y
authors.lastname: Ding
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Yang
authors.forename: Shaoshan
authors.initials: S
authors.lastname: Liang
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.forename: Qian
authors.initials: Q
authors.lastname: Huang
authors.forename: Hongbing
authors.initials: H
authors.lastname: Shen
authors.forename: Jianming
authors.initials: J
authors.lastname: Wang
authors.forename: Agnes B
authors.initials: AB
authors.lastname: Fogo
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D001284:Atrophy; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007684:Kidney Tubules / Q000473:pathology; D008297:Male