Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch–Schönlein purpura nephritis in adults


Recently, there has been emerging concern that crescents, the main histologic feature of Henoch–Schönlein purpura nephritis, merely reflect active inflammation, and may not be useful in predicting long-term outcomes. We therefore conducted a single-center retrospective study to evaluate whether the new Oxford classification of immunoglobulin A nephropathy can be used to predict long-term outcome in patients with Henoch–Schönlein purpura nephritis. We included 61 biopsy-proven patients with Henoch–Schönlein purpura nephritis between January 1991 and August 2010. In addition to the International Study of Kidney Disease in Children classification, pathologic findings were also evaluated by the Oxford classification. Primary outcomes were defined as either the onset of estimated glomerular filtration rate <60 ml/min per 1.73 m2 with ≥30% decrease in estimated glomerular filtration rate from baseline or end-stage renal disease. During a median follow-up of 49.3 months, 13 (21%) patients reached the primary end point. A Kaplan–Meier plot showed that renal event-free survival was significantly longer in patients with <50% crescents than in those with crescents in ≥50% of glomeruli (P=0.003). Among the components of the Oxford classification, patients with endocapillary hypercellularity (E1; P=0.016) and tubular atrophy/interstitial fibrosis (T1/T2; P=0.018) had lower renal survival rates than those with E0 and T0. In a multivariate Cox model adjusted for clinical and pathologic factors, E1 (hazard ratio=8.91; 95% confidence interval=1.47–53.88; P=0.017) and T1/T2 (hazard ratio=8.74; 95% confidence interval=1.40–54.38; P=0.020) were independently associated with reaching a primary outcome, whereas the extent of crescentic lesions was not. Our findings suggest that the Oxford classification can be used in predicting long-term outcomes of Henoch–Schönlein purpura nephritis.

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  1. 1

    D'Amico G . Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol 2004;24:179–196.

  2. 2

    Boyd JK, Cheung CK, Molyneux K et al. An update on the pathogenesis and treatment of IgA nephropathy. Kidney Int 2012;81:833–843.

  3. 3

    Evans DJ, Williams DG, Peters DK et al. Glomerular deposition of properdin in Henoch-Schonlein syndrome and idiopathic focal nephritis. Br Med J 1973;3:326–328.

  4. 4

    Waldo FB . Is Henoch-Schonlein purpura the systemic form of IgA nephropathy? Am J Kidney Dis 1988;12:373–377.

  5. 5

    Davin JC, Ten Berge IJ, Weening JJ . What is the difference between IgA nephropathy and Henoch-Schonlein purpura nephritis? Kidney Int 2001;59:823–834.

  6. 6

    Oh HJ, Ahn SV, Yoo DE et al. Clinical outcomes, when matched at presentation, do not vary between adult-onset Henoch-Schonlein purpura nephritis and IgA nephropathy. Kidney Int 2012;82:1304–1312.

  7. 7

    Goldstein AR, White RH, Akuse R et al. Long-term follow-up of childhood Henoch-Schonlein nephritis. Lancet 1992;339:280–282.

  8. 8

    Niaudet P, Habib R . Schonlein-Henoch purpura nephritis: prognostic factors and therapy. Ann Med Interne (Paris) 1994;145:577–580.

  9. 9

    Coppo R, Andrulli S, Amore A et al. Predictors of outcome in Henoch-Schonlein nephritis in children and adults. Am J Kidney Dis 2006;47:993–1003.

  10. 10

    Pillebout E, Thervet E, Hill G et al. Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271–1278.

  11. 11

    Shrestha S, Sumingan N, Tan J et al. Henoch Schonlein purpura with nephritis in adults: adverse prognostic indicators in a UK population. QJM 2006;99:253–265.

  12. 12

    Ronkainen J, Nuutinen M, Koskimies O . The adult kidney 24 years after childhood Henoch-Schonlein purpura: a retrospective cohort study. Lancet 2002;360:666–670.

  13. 13

    Haas M . IgA nephropathy and Henoch-Schönlein purpura In: Jennette JC, Olson JL, Schwartz MM, Silva FG, (eds) Pathology of the Kidney 6th edn Lippincott Williams & Wilkins: Phildelphia, 2007, pp 423–486.

  14. 14

    Coppo R, Mazzucco G, Cagnoli L et al. Long-term prognosis of Henoch-Schonlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schonlein purpura. Nephrol Dial Transplant 1997;12:2277–2283.

  15. 15

    Davin JC . Henoch-Schonlein purpura nephritis: pathophysiology, treatment, and future strategy. Clin J Am Soc Nephrol 2011;6:679–689.

  16. 16

    Cattran DC, Coppo R, Cook HT et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 2009;76:534–545.

  17. 17

    Roberts IS, Cook HT, Troyanov S et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 2009;76:546–556.

  18. 18

    Coppo R, Troyanov S, Camilla R et al. The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults. Kidney Int 2010;77:921–927.

  19. 19

    Alamartine E, Sauron C, Laurent B et al. The use of the Oxford classification of IgA nephropathy to predict renal survival. Clin J Am Soc Nephrol 2011;6:2384–2388.

  20. 20

    Herzenberg AM, Fogo AB, Reich HN et al. Validation of the Oxford classification of IgA nephropathy. Kidney Int 2011;80:310–317.

  21. 21

    Katafuchi R, Ninomiya T, Nagata M et al. Validation study of oxford classification of IgA nephropathy: the significance of extracapillary proliferation. Clin J Am Soc Nephrol 2011;6:2806–2813.

  22. 22

    Shi SF, Wang SX, Jiang L et al. Pathologic predictors of renal outcome and therapeutic efficacy in IgA nephropathy: validation of the oxford classification. Clin J Am Soc Nephrol 2011;6:2175–2184.

  23. 23

    Fogo AB . Approach to renal biopsy. Am J Kidney Dis 2003;42:826–836.

  24. 24

    Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–612.

  25. 25

    Lau KK, Suzuki H, Novak J et al. Pathogenesis of Henoch-Schonlein purpura nephritis. Pediatr Nephrol 2010;25:19–26.

  26. 26

    Szeto CC, Choi PC, To KF et al. Grading of acute and chronic renal lesions in Henoch-Schonlein purpura. Mod Pathol 2001;14:635–640.

  27. 27

    Markowitz GS, D'Agati VD . Classification of lupus nephritis. Curr Opin Nephrol Hypertens 2009;18:220–225.

  28. 28

    Sprangers B, Monahan M, Appel GB . Diagnosis and treatment of lupus nephritis flares-an update. Nat Rev Nephrol 2012;8:709–717.

  29. 29

    Eison TM, Ault BH, Jones DP et al. Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol 2011;26:165–180.

  30. 30

    Liu LJ, Li GT, Zhou Y et al. Clinicopathologic features and outcomes in endocapillary proliferative IgA nephropathy. Nephron Clin Pract 2010;115:c161–c167.

  31. 31

    Tipping PG, Kitching PR, Holdsworth SR . The formation of glomerular crescents In: Neilson EG, Couser WG, (eds) Immunologic Renal Diseases 2nd edn Lippingcott Williams & Wilkins Publishers: Philadelphia, 2001.

  32. 32

    Rauta V, Tornroth T, Gronhagen-Riska C . Henoch-Schoenlein nephritis in adults-clinical features and outcomes in Finnish patients. Clin Nephrol 2002;58:1–8.

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This study was supported by a faculty research grant of Yonsei University College of Medicine for 2012 (6-2012-0033); and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).

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Correspondence to Seung Hyeok Han.

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Ho Kim, C., Jin Lim, B., Sung Bae, Y. et al. Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch–Schönlein purpura nephritis in adults. Mod Pathol 27, 972–982 (2014) doi:10.1038/modpathol.2013.222

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  • crescents
  • Henoch–Schönlein purpura nephritis
  • long-term outcome
  • the Oxford classification

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