TY - JOUR
T1 - Oxford Classification of IgA nephropathy 2016
T2 - an update from the IgA Nephropathy Classification Working Group
AU - Trimarchi, Hernán
AU - Barratt, Jonathan
AU - Cattran, Daniel C.
AU - Cook, H. Terence
AU - Coppo, Rosanna
AU - Haas, Mark
AU - Liu, Zhi Hong
AU - Roberts, Ian S.D.
AU - Yuzawa, Yukio
AU - Zhang, Hong
AU - Feehally, John
AU - Alpers, Charles E.
AU - Asunis, Ana María
AU - Barbour, Sean
AU - Becker, Jan U.
AU - Ding, Jie
AU - Espino, Gabriella
AU - Ferrario, Franco
AU - Fogo, Agnes
AU - Hladunewich, Michelle
AU - Joh, Kensuke
AU - Katafuchi, Ritsuko
AU - Lv, Jicheng
AU - Matsuzaki, Keiichi
AU - Nakanishi, Koichi
AU - Pani, Antonello
AU - Perera, Ran
AU - Perkowska-Ptasinska, Agnieszka
AU - Reich, Heather
AU - Shima, Yuko
AU - Soares, Maria Fernanda
AU - Suzuki, Yusuke
AU - Takahashi, Katsuo
AU - Troyanov, Stéphan
AU - Verhave, Jacobien C.
AU - Wang, Suxia
AU - Weening, Jan
AU - Wyatt, Robert
AU - Yoshikawa, Nori
AU - Zeng, Caihong
N1 - Publisher Copyright:
© 2017 International Society of Nephrology
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Since the Oxford Classification of IgA nephropathy (IgAN) was published in 2009, MEST scores have been increasingly used in clinical practice. Further retrospective cohort studies have confirmed that in biopsy specimens with a minimum of 8 glomeruli, mesangial hypercellularity (M), segmental sclerosis (S), and interstitial fibrosis/tubular atrophy (T) lesions predict clinical outcome. In a larger, more broadly based cohort than in the original Oxford study, crescents (C) are predictive of outcome, and we now recommend that C be added to the MEST score, and biopsy reporting should provide a MEST-C score. Inconsistencies in the reporting of M and endocapillary cellularity (E) lesions have been reported, so a web-based educational tool to assist pathologists has been developed. A large study showed E lesions are predictive of outcome in children and adults, but only in those without immunosuppression. A review of S lesions suggests there may be clinical utility in the subclassification of segmental sclerosis, identifying those cases with evidence of podocyte damage. It has now been shown that combining the MEST score with clinical data at biopsy provides the same predictive power as monitoring clinical data for 2 years; this requires further evaluation to assess earlier effective treatment intervention. The IgAN Classification Working Group has established a well-characterized dataset from a large cohort of adults and children with IgAN that will provide a substrate for further studies to refine risk prediction and clinical utility, including the MEST-C score and other factors.
AB - Since the Oxford Classification of IgA nephropathy (IgAN) was published in 2009, MEST scores have been increasingly used in clinical practice. Further retrospective cohort studies have confirmed that in biopsy specimens with a minimum of 8 glomeruli, mesangial hypercellularity (M), segmental sclerosis (S), and interstitial fibrosis/tubular atrophy (T) lesions predict clinical outcome. In a larger, more broadly based cohort than in the original Oxford study, crescents (C) are predictive of outcome, and we now recommend that C be added to the MEST score, and biopsy reporting should provide a MEST-C score. Inconsistencies in the reporting of M and endocapillary cellularity (E) lesions have been reported, so a web-based educational tool to assist pathologists has been developed. A large study showed E lesions are predictive of outcome in children and adults, but only in those without immunosuppression. A review of S lesions suggests there may be clinical utility in the subclassification of segmental sclerosis, identifying those cases with evidence of podocyte damage. It has now been shown that combining the MEST score with clinical data at biopsy provides the same predictive power as monitoring clinical data for 2 years; this requires further evaluation to assess earlier effective treatment intervention. The IgAN Classification Working Group has established a well-characterized dataset from a large cohort of adults and children with IgAN that will provide a substrate for further studies to refine risk prediction and clinical utility, including the MEST-C score and other factors.
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U2 - 10.1016/j.kint.2017.02.003
DO - 10.1016/j.kint.2017.02.003
M3 - Article
C2 - 28341274
AN - SCOPUS:85015786890
SN - 0085-2538
VL - 91
SP - 1014
EP - 1021
JO - Kidney International
JF - Kidney International
IS - 5
ER -