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|Title:||Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group.|
Cattran, Daniel C.
Cook, H. Terence
Roberts, Ian S. D.
IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society
|Publisher:||Elsevier for International Society of Nephrology|
|Citation:||Kidney International, 2017, 91 (5), pp. 1014-1021|
|Abstract:||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.|
|Rights:||Copyright © 2017, Elsevier for International Society of Nephrology. Deposited with reference to the publisher’s open access archiving policy.|
|Description:||The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.|
|Appears in Collections:||Published Articles, Dept. of Infection, Immunity and Inflammation|
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