Application Of The Oxford Classification For Children With IgA Nephropathy

Objective:Make validation of the Oxford classification for children with IgAnephr-opathy (IgAN).Methods:Clinical and pathological data at renal biopsy of123children with IgANwere analysed retrospectively from Jan.2010to Sep.2013.84children we-re followed up. The results were divided into4grades (A, B, C, D) basedon the manifestations at the end of follow-up.Results:1. There were54children (42.3%) with nephrotic syndrome,30children(24.4%) with hematuria merged with proteinuria,25children (20.3%) withpure hematuria,15children (12.2%) with acute glomerulonephritis andonly1child (0.8%) with chronic glomerulonephritis. NS groups had higherscores than other clinical types (P<0.01).2. There were101children (82.1%) with mesangial hypercellularity(M1),66children (53.7%) with endocapillary hypercellularity (E1),50children (40.7%) with segmental glomerulosclerosis (S1),21children (17.1%) with moderate tubular atrophy/interstitial fibrosis (T1), only1child (0.8%) with severe tubular atrophy/interstitial fibrosis (T2).3. M1and E1groups had longer course of disease than M0and E0groups (P<0.05).All of scores were in connection with the age at biopsy e-xcluding mesangial hypercellularity (P<0.05).4. M1and E1lesions were related to severer hematuria (P<0.01) and allof lesions had relations with edema (P<0.05) apart from S lesion. All ofgroups were statistically different in mean artery pressure(P<0.05) exceptfor endocapillary hypercellularity.5. M, E, S and T scores were strongly associated with24hour urinaryprotein excretion (P<0.01). The eGFR of S1and T1/T2groups were lowerthan S0and T0groups (P<0.01).6. Only S score had significant association with mesangial IgA and C3deposition scores (P<0.05). The mesangial IgG deposition score wasassociated with severer M, E and S lesions (P<0.05).7. There were43children (51.2%) with grade A,30children(31.7%)with grade B,8children (9.5%) with grade C and3children (3.6%) withgrade D at the end of follow-up. Only T lesion was associated withprognosis (P<0.05).Conclusion:The Oxford classification was significantly associtaed with clinical feat-ures for children with IgAN. Mesangial and endocapillary hypercellularity were as indicators of disease activity and had little value on prognosis.Despite segmental glomerulosclerosis had nothing to do with short-termoutcome, the long-tem prognostic significance of S score needed morevalidation. Tubular atrophy/interstitial fibrosis was a risk factor of unfavor-able renal outcome. Correlations of immunostaining findings and variablesof Oxford classification required further studies.