title: Clinical usefulness of the Oxford classification in determining immunosuppressive treatment in IgA nephropathy.
abstract: The Oxford classification has been widely used in IgA nephropathy. However, its clinical usefulness of determining immunosuppression is unknown.
  
  
  
  Whether the Oxford classification could predict the development of proteinuria ≥1 g/g Cr and worsening kidney function, as well as the clinical efficacy of corticosteroid treatment according to each histologic variable of the Oxford-MEST.
  
  
  
  We included 377 patients with early-stage IgA nephropathy. The study endpoints were the development of a heavy proteinuria and a decline renal function.
  
  
  
  The results showed that among the Oxford-MEST lesions, only M1 predicted the risk of the development of proteinuria ≥1.0 g/g Cr compared to other lesions in a time-varying Cox model adjusted for multiple confounding factors. In addition, the risk of reaching a 30% decline in eGFR was significantly higher in patients with M1 than in those with M0. Furthermore, patients with M1 had a greater decline of eGFR than patients with M0. However, steroid treatment in M1 lesion was not associated with improving clinical outcomes in the unmatched and propensity score matched cohort.
  
  
  
  This finding may provide a rationale for using the Oxford classification as a guidance to initiate immunosuppression in the early stages of IgA nephropathy. KEY MESSAGES M1 has independently predictive role among the Oxford lesions in IgA nephropathy. Oxford classification should be defined during pathologic approach. Decision of starting immunosuppression according to the Oxford lesions.
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Chang-Yun
authors.initials: CY
authors.lastname: Yoon
authors.affiliation: b Division of Nephrology, Department of Internal Medicine , National Health Insurance Service Medical Center, Ilsan Hospital , Goyang, Gyeonggi-do , Republic of Korea.
authors.forename: Tae Ik
authors.initials: TI
authors.lastname: Chang
authors.affiliation: b Division of Nephrology, Department of Internal Medicine , National Health Insurance Service Medical Center, Ilsan Hospital , Goyang, Gyeonggi-do , Republic of Korea.
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.affiliation: c Department of Pathology , Yonsei University College of Medicine , Seoul , Republic of Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Lim
authors.affiliation: d Department of Pathology , National Health Insurance Corporation Ilsan Hospital , Goyang , Republic of Korea.
authors.forename: Jeong Hae
authors.initials: JH
authors.lastname: Kie
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Youn Kyung
authors.initials: YK
authors.lastname: Kee
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Hyoungnae
authors.initials: H
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Seohyun
authors.initials: S
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Yun
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Su-Young
authors.initials: SY
authors.lastname: Jung
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Jhee
authors.affiliation: e Division of Nephrology, Department of Internal Medicine , Myongji Hospital, Seonam University College of Medicine , Goyang, Gyeonggi-do , Republic of Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: f Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital , Seoul , Republic of Korea.
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: c Department of Pathology , Yonsei University College of Medicine , Seoul , Republic of Korea.
authors.forename: Hyeon Joo
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: a Department of Internal Medicine , College of Medicine, Institute of Kidney Disease Research, Yonsei University , Seoul , Republic of Korea.
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005922:Glomerulonephritis, IGA / Q000145:classification / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D051437:Renal Insufficiency / Q000150:complications / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: IgA nephropathy; Oxford classification; glucocorticoid treatment; proteinuria