Comparison of the Haas and the Oxford classifications for prediction of renal outcome in patients with IgA nephropathy.
Pathologic features can provide valuable information for determining prognosis in IgA nephropathy (IgAN). However, it is uncertain whether the Oxford classification, a new classification of IgAN, can predict renal outcome better than previous ones. We conducted a retrospective cohort study in 500 patients with biopsy-proven IgAN between January 2002 and December 2010 to compare the ability of the Haas and the Oxford classifications to predict renal outcome. Primary outcome was a doubling of the baseline serum creatinine concentration (D-SCr). During a mean follow-up of 68 months, 52 (10.4%) and 35 (7.0%) developed D-SCr and end-stage renal disease, respectively. There were graded increases in the development of D-SCr in the higher Haas classes. In addition, the primary endpoint of D-SCr occurred more in patients with the Oxford M and T lesions than those without such lesions. In multivariate Cox regression analyses, the Haas class V (HR, 12.19; P=.002) and the Oxford T1 (hazard ratio [HR], 6.68; P<.001) and T2 (HR, 12.16; P<.001) lesions were independently associated with an increased risk of reaching D-SCr. Harrell's C index of each multivariate model with the Haas and the Oxford classification was 0.867 (P=.015) and 0.881 (P=.004), respectively. This was significantly higher than that of model with clinical factors only (C=0.819). However, there was no difference in C-statistics between the 2 models with the Haas and the Oxford classifications (P=.348). This study suggests that the Haas and the Oxford classifications are comparable in predicting progression of IgAN.
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Kyoung Sook
KS
Park
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Seung Hyeok
SH
Han
Department of Pathology, NHIS Ilsan Hospital, Goyang-shi, Gyeonggi-do, South Korea.
Jeong Hae
JH
Kie
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Ki Heon
KH
Nam
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Mi Jung
MJ
Lee
Department of Pathology, College of Medicine, Yonsei University, Seoul, South Korea.
Beom Jin
BJ
Lim
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Young Eun
YE
Kwon
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Yung Ly
YL
Kim
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Seong Yeong
SY
An
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Chan Ho
CH
Kim
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Fa Mee
FM
Doh
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Hyang Mo
HM
Koo
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Hyung Jung
HJ
Oh
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea; Severance Biomedical Science Institute, Brain Korea 21, Yonsei University, Seoul, South Korea.
Shin-Wook
SW
Kang
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.
Kyu Hun
KH
Choi
Department of Pathology, College of Medicine, Yonsei University, Seoul, South Korea.
Hyeon Joo
HJ
Jeong
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea. Electronic address: yoosy0316@yuhs.ac.
Tae-Hyun
TH
Yoo
D000328:Adult; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005922:Glomerulonephritis, IGA / Q000145:classification* / Q000150:complications* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
D003404:Creatinine
IgA nephropathy; Long-term outcome; Proteinuria