title: Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein purpura nephritis in adults.
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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Pathology, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Lim
authors.affiliation: Department of Pathology, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Yoon Sung
authors.initials: YS
authors.lastname: Bae
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Yung Ly
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Ki Heon
authors.initials: KH
authors.lastname: Nam
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Kyoung Sook
authors.initials: KS
authors.lastname: Park
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Seong Yeong
authors.initials: SY
authors.lastname: An
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Hyang Mo
authors.initials: HM
authors.lastname: Koo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Fa Mee
authors.initials: FM
authors.lastname: Doh
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.affiliation: 1] Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea [2] Severance Biomedical Science Institute, Yonsei University, Brain Korea 21, Seoul, Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Pathology, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005922:Glomerulonephritis, IGA / Q000145:classification / Q000473:pathology*; D006801:Humans; D011695:IgA Vasculitis / Q000145:classification / Q000473:pathology*; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult