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Abstract: TH-PO1026

Combinatory Approach of Oxford Classification Allows a Tailored Prediction of Renal Death in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Robin, Chazot, CHU Saint Etienne, Saint Etienne, France
  • Jullien, Perrine, CHU Saint Etienne, Saint Etienne, France
  • Laurent, Blandine, CHU Saint Etienne, Saint Etienne, France
  • Dinic, Miriana, CHU Saint Etienne, Saint Etienne, France
  • Thibaudin, Damien, CHU Saint Etienne, Saint Etienne, France
  • Alamartine, Eric, Chu St Etienne Hospital Nord, Saint Priest En Jarez Cedex, France
  • Mariat, Christopher R., CHU Saint Etienne, Saint Etienne, France
  • Maillard, Nicolas, CHU Saint Etienne, Saint Etienne, France
Background

The prognostic of IgA nephropathy (IgAN) is highly heterogeneous, ranging from isolated hematuria to End-Stage Renal Disease (ESRD).
The Oxford classification has been developed and recently updated to stratify patients according to the risk of progression considering histological elementary lesions. From a clinical standpoint, each patient has a proper combination of Oxford classification lesions, but
the knowledge about the distribution and the prognostic impact of such combinations is lacking.
Our study describes the distribution of those combinations in our population and evaluate their particular association with renal death.

Methods

This retrospective, monocentric cohort study included all Caucasian patients with biopsy-proven IgAN since 1979. Renal biopsies were scored by one pathologist blinded to the clinical data and according to the Oxford classification. We analyzed the distribution and grouped the patients according to the combination of histological MESTC score components to assess their risk to progress to ESRD (cox model, non adjusted and adjusted on proteinuria, hypertension, eGFR).

Results

A total of 695 patients were retained for analysis (mean age and proteinuria respectively 38.6 years and 1.04 g/day).
The distribution of combinations was heterogenous: Most frequent lesions were M0S0E0T0C0, S1 alone, combined S1 and T1 alone, as shown in Figure 1. M0S0E0T0 was set as the reference (Hazard Ratio (HR) for progression =1).
The higher and significant unadjusted risk for progression was found for the association S1E1T1 ( HR 38.14 [14.9;97.7]), S1T1 (HR 24.87 [12 ; 51.7]), S1E1C1 (HR 8.02[3.38;19.01]), M1S1E1 (HR 7.69[2.36;25.0]), S1E1 (HR 3.88 [1.22;12.39]) as shown in Figure 2.
Isolated S1 (HR 1.35 [0.52;3.5]), isolated M1 (HR 1,43 [0,18;11,3]), were not significantly associated with renal death contrary to isolated T1 (HR 14.7 [4.39;43.5]) and isolated E1 (HR 5.34 [1.46;19.5]).

Conclusion

This combinatory approach of Oxford classification lesions allows to identifying the unbalanced histological combinations with better homogeneity in renal outcomes prediction. Isolated M1 and S1 lesions did not seem to associate with ESRD.