|Evaluation of the Oxford Classification of IgA Nephropathy: A Systematic Review and Meta-analysis|
|Lv, Jicheng1,2,3,4; Shi, Sufang1,2,3,4; Xu, Damin1,2,3,4; Zhang, Hong1,2,3,4; Troyanov, Stephan5; Cattran, Daniel C.6; Wang, Haiyan1,2,3,4|
|关键词||Immunoglobulin a (Iga) Nephropathy Oxford Classification Meta-analysis|
|刊名||AMERICAN JOURNAL OF KIDNEY DISEASES|
|WOS标题词||Science & Technology|
|类目[WOS]||Urology & Nephrology|
|研究领域[WOS]||Urology & Nephrology|
|关键词[WOS]||PATHOLOGICAL PREDICTORS ; NATURAL-HISTORY ; RENAL SURVIVAL ; VALIDATION ; PROTEINURIA ; PROGNOSIS ; CHILDREN ; DISEASE ; ADULTS|
Background: The Oxford Classification of the pathology of immunoglobulin A (IgA) nephropathy, developed in 2009, is highly predictive of renal prognosis. It has been validated in different populations, but the results remain inconsistent.
Study Design: Systematic review and meta-analysis.
Setting & Population: Patients with biopsy-proven primary IgA nephropathy.
Selection Criteria for Studies: Studies assessing the Oxford Classification of IgA nephropathy published between January 2009 and December 2012 were included following systematic searching of the MEDLINE and EMBASE databases.
Predictor: 4 pathologic lesions of the Oxford Classification: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T).
Outcome: Kidney failure defined as doubled serum creatinine level, 50% decline in estimated glomerular filtration rate, or end-stage kidney disease.
Results: 16 retrospective cohort studies with 3,893 patients and 570 kidney failure events were included. In a multivariate model, HRs for kidney failure were 0.6 (95% CI, 0.5-0.8; P < 0.001), 1.8 (95% CI, 1.4-2.4; P < 0.001), and 3.2 (95% CI, 1.8-5.6; P < 0.001) for scores of M0 (mesangial hypercellularity score <= 0.5), S1 (presence of segmental glomerulosclerosis), and T1/2 (> 25% tubular atrophy/interstitial fibrosis), respectively, without evidence of heterogeneity. Pooled results showed that E lesions were not associated with kidney failure (HR, 1.4; 95% CI, 0.9-2.0; P = 0.1), with evidence of heterogeneity (I-2 = 54.1%; P = 0.01). Crescent (C) lesions were associated with kidney failure (HR, 2.3; 95% CI, 1.6-3.4; P = 0.001), with no evidence of heterogeneity (I-2 = 14.7%; P = 0.3).
Limitations: All studies were retrospective. This was not an individual-patient-data meta-analysis.
Conclusions: This study suggests that M, S, T, and C lesions, but not E lesions, are associated strongly with progression to kidney failure and thus should be included in the Oxford Classification system. (C) 2013 by the National Kidney Foundation, Inc.
|项目编号||2012CB517700 ; 81270795 ; 30825021 ; 81021004 ; NCET-12-0011|
|资助机构||Major State Basic Research Development Program of China (973 program) ; National Natural Science Foundation of China ; Natural Science Fund of China to the Innovation Research Group ; Ministry of Education of China|
|作者单位||1.Peking Univ, Hosp 1, Dept Med, Div Renal, Beijing 100034, Peoples R China|
2.Peking Univ, Inst Nephrol, Beijing 100034, Peoples R China
3.Minist Hlth China, Key Lab Renal Dis, Beijing, Peoples R China
4.Peking Univ, Minist Educ, Key Lab Chron Kidney Dis Prevent & Treatment, Beijing 100034, Peoples R China
5.Univ Montreal, Hop Sacre Coeur Montreal, Dept Nephrol, Montreal, PQ, Canada
6.Univ Toronto, Toronto Gen Hosp, Div Nephrol, Toronto, ON M5S 1A1, Canada
|Lv, Jicheng,Shi, Sufang,Xu, Damin,et al. Evaluation of the Oxford Classification of IgA Nephropathy: A Systematic Review and Meta-analysis[J]. AMERICAN JOURNAL OF KIDNEY DISEASES,2013,62(5):891-899.|
|APA||Lv, Jicheng.,Shi, Sufang.,Xu, Damin.,Zhang, Hong.,Troyanov, Stephan.,...&Wang, Haiyan.(2013).Evaluation of the Oxford Classification of IgA Nephropathy: A Systematic Review and Meta-analysis.AMERICAN JOURNAL OF KIDNEY DISEASES,62(5),891-899.|
|MLA||Lv, Jicheng,et al."Evaluation of the Oxford Classification of IgA Nephropathy: A Systematic Review and Meta-analysis".AMERICAN JOURNAL OF KIDNEY DISEASES 62.5(2013):891-899.|