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Abstract: PO1588

Novel Scoring System Based on the Oxford Classification Indicating Steroid Therapy Use for IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Moriyama, Takahito, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Kasama, Eri, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Miyabe, Yoei, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Akiyama, Kenichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Karasawa, Kazunori, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
Background

The Oxford classification identifies predictors of the renal prognosis for IgA nephropathy (IgAN); however, it has been unclear about usefulness for deciding the management approach. We analyzed the clinical utility of this classification for indicating steroid therapy.

Methods

The effects of steroid therapy on the long-term prognosis for all 858 IgAN patients and patients divided with M0, M1, E0, E1, S0, S1, T0, T1, T2, C0, C1 and C2 scores according to the Oxford classification (M, mesangial hypercellularity; E, endocapillary hypercellularity; S, segmental sclerosis; T, tubular atrophy/interstitial fibrosis; and C, crescents) were examined using Kaplan-Meier analysis and Cox regression analysis. The steroid responder score (SRS) and steroid non-responder score (SNRS) were determined using the obtained results. The effects of steroid therapy on renal prognosis according to the combination of the total SRS and SNRS for IgAN were analyzed using Cox regression analysis.

Results

Steroid therapy improved the 20-year renal survival rates in all IgAN patients (steroid (+): 75.5% vs. steroid (-): 61.7%, p=0.025) and patients with M1, E1, S1, C1, and T0 scores. We recognized the total score of M1, E1, S1, and C1 scores (0–4 points) as the SRS and that of T1 and T2 scores (0–2 points) as the SNRS. Multivariate Cox regression analysis revealed that steroid therapy improved the long-term renal prognosis in IgAN patients with higher SRS and lower SNRS (SRS4/SNRS0: hazard ratio [HR], 0.08 and p=0.008; SRS3/SNRS0: HR, 0.05 and p=0.025; SRS4/SNRS1: HR, 0.11 and p=0.007), but not in IgAN patients with lower SRS (0–3)/SNRS1 and any SRS/SNRS2.

Conclusion

Patients with M1, E1, S1, and C1 scores responded to steroid treatment; contrarily, those with T1 and T2 scores did not. A higher SRS was a useful indicator for steroid therapy. Nevertheless, prevention of progression in IgAN patients with SNRS was difficult with steroid therapy.