TY - JOUR
T1 - Evidence from the Oxford Classification cohort supports the clinical value of subclassification of focal segmental glomerulosclerosis in IgA nephropathy
AU - International IgA Nephropathy Working Group
AU - International IgA Nephropathy Working Group
AU - Bellur, Shubha S.
AU - Lepeytre, Fanny
AU - Vorobyeva, Olga
AU - Troyanov, Stéphan
AU - Cook, H. Terence
AU - Roberts, Ian S.D.
AU - Alpers, Charles E.
AU - Amore, Alessandro
AU - Barratt, Jonathan
AU - Berthoux, Francois
AU - Bonsib, Stephen
AU - Bruijn, Jan A.
AU - Cattran, Daniel C.
AU - Coppo, Rosanna
AU - D'Agati, Vivette
AU - D'Amico, Giuseppe
AU - Emancipator, Steven
AU - Emma, Francesco
AU - Feehally, John
AU - Ferrario, Franco
AU - Fervenza, Fernando C.
AU - Florquin, Sandrine
AU - Fogo, Agnes
AU - Geddes, Colin C.
AU - Groene, Hermann Josef
AU - Haas, Mark
AU - Herzenberg, Andrew M.
AU - Hill, Prue A.
AU - Hogg, Ronald J.
AU - Hsu, Stephen I.
AU - Jennette, J. Charles
AU - Joh, Kensuke
AU - Julian, Bruce A.
AU - Kawamura, Tetsuya
AU - Lai, Fernand M.
AU - Li, Lei Shi
AU - Li, Philip K.T.
AU - Liu, Zhi Hong
AU - Mackinnon, Bruce
AU - Mezzano, Sergio
AU - Schena, F. Paolo
AU - Tomino, Yasuhiko
AU - Walker, Patrick D.
AU - Wang, Haiyan
AU - Weening, Jan J.
AU - Yoshikawa, Nori
AU - Zhang, Hong
N1 - Publisher Copyright:
© 2016 International Society of Nephrology
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Focal segmental glomerulosclerosis (FSGS) is a common finding in IgA nephropathy (IgAN). Here we assessed FSGS lesions in the Oxford Classification patient cohort and correlated histology with clinical presentation and outcome to determine whether subclassification of the S score in IgAN is reproducible and of clinical value. Our subclassification of lesions in 137 individuals with segmental glomerulosclerosis or adhesion (S1) identified 38% with podocyte hypertrophy, 10% with hyalinosis, 9% with resorption droplets within podocytes, 7% with tip lesions, 3% with perihilar sclerosis, and 2% with endocapillary foam cells. Reproducibility was good or excellent for tip lesions, hyalinosis, and perihilar sclerosis; moderate for podocyte hypertrophy; and poor for resorption droplets, adhesion only, and endocapillary foam cells. Podocyte hypertrophy and tip lesions were strongly associated with greater initial proteinuria. During follow-up of patients without immunosuppression, those with these features had more rapid renal function decline and worse survival from a combined event compared to S1 patients without such features and those without FSGS. Also in individuals with podocyte hypertrophy or tip lesions, immunosuppressive therapy was associated with better renal survival. In IgA nephropathy, the presence of podocyte hypertrophy or tip lesions, markers of podocyte injury, were reproducible. These features are strongly associated with proteinuria and, in untreated patients, carry a worse prognosis. Thus, our findings support reporting podocytopathic features alongside the S score of the Oxford Classification.
AB - Focal segmental glomerulosclerosis (FSGS) is a common finding in IgA nephropathy (IgAN). Here we assessed FSGS lesions in the Oxford Classification patient cohort and correlated histology with clinical presentation and outcome to determine whether subclassification of the S score in IgAN is reproducible and of clinical value. Our subclassification of lesions in 137 individuals with segmental glomerulosclerosis or adhesion (S1) identified 38% with podocyte hypertrophy, 10% with hyalinosis, 9% with resorption droplets within podocytes, 7% with tip lesions, 3% with perihilar sclerosis, and 2% with endocapillary foam cells. Reproducibility was good or excellent for tip lesions, hyalinosis, and perihilar sclerosis; moderate for podocyte hypertrophy; and poor for resorption droplets, adhesion only, and endocapillary foam cells. Podocyte hypertrophy and tip lesions were strongly associated with greater initial proteinuria. During follow-up of patients without immunosuppression, those with these features had more rapid renal function decline and worse survival from a combined event compared to S1 patients without such features and those without FSGS. Also in individuals with podocyte hypertrophy or tip lesions, immunosuppressive therapy was associated with better renal survival. In IgA nephropathy, the presence of podocyte hypertrophy or tip lesions, markers of podocyte injury, were reproducible. These features are strongly associated with proteinuria and, in untreated patients, carry a worse prognosis. Thus, our findings support reporting podocytopathic features alongside the S score of the Oxford Classification.
KW - IgA nephropathy
KW - podocytopathy
KW - segmental sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85006513322&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006513322&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2016.09.029
DO - 10.1016/j.kint.2016.09.029
M3 - Article
C2 - 27914703
AN - SCOPUS:85006513322
SN - 0085-2538
VL - 91
SP - 235
EP - 243
JO - Kidney international
JF - Kidney international
IS - 1
ER -