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. 2019 May 10;14(1):40.
doi: 10.1186/s13000-019-0818-0.

Updated Oxford classification and the international study of kidney disease in children classification: application in predicting outcome of Henoch-Schönlein purpura nephritis

Xiaohan Huang  1   2   3   4 , Lili Ma  1   5 , Pingping Ren  1   2   3   4 , Hongya Wang  1   2   3   4 , Liangliang Chen  1   2   3   4 , Haidongqin Han  1   2   3   4 , Jianghua Chen  1   2   3   4 , Fei Han  6   7   8   9
Affiliations

Updated Oxford classification and the international study of kidney disease in children classification: application in predicting outcome of Henoch-Schönlein purpura nephritis

Xiaohan Huang et al. Diagn Pathol. .

Abstract

Background: Henoch-Schönlein purpura nephritis (HSPN) shares many similarities with IgA nephropathy. We aimed to analyze the predictive value of the International Study of Kidney Disease in Children (ISKDC) classification and the updated Oxford classification for IgA nephropathy in HSPN patients.

Methods: Data of 275 HSPN patients (aged≥14 years) were retrieved, and all of them underwent a renal biopsy. We re-classified the biopsies according to the ISKDC classification and the updated Oxford classification to analyze their correlations with clinical features and renal outcomes. The renal endpoints were defined as ≥30% reduction in baseline estimated glomerular filtration rate (eGFR) in 2 years, doubling of serum creatinine (Scr) or end stage renal disease.

Results: During follow-up period of 56(30,86) months, 30(10.9%) patients reached renal endpoints. Segmental sclerosis was the only pathological feature independently associated with renal endpoints (HR 4.086, 95%CI 1.111-15.026, P = 0.034). Tubular atrophy/ interstitial fibrosis was associated with eGFR and Scr levels, and its correlation with renal endpoints was found by univariate analysis. Endocapillary hypercellularity was associated with 24 h urine protein and is of prognostic value in univariate analysis. Mesangial hypercellularity was not associated with clinical features or renal endpoints. Crescents were associated with 24 h urine protein, Scr and eGFR levels, but both ISKDC and updated Oxford classifications of crescents were not associated with renal endpoints by multivariate analysis.

Conclusions: The updated Oxford classification can help in disease management and renal outcome prediction of HSPN.

Keywords: Crescent; IgA vasculitis; Nephritis; Outcomes; Renal biopsy.

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Conflict of interest statement

Ethics approval and consent to participate

The Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University approved the protocols (Reference number: 2017678). Due to the retrospective nature of the study, informed consent was waived.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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