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J Nephropathol. 2022;11(4): e18395.
doi: 10.34172/jnp.2022.18395
  Abstract View: 100
  PDF Download: 55

Review

Risk stratification and long-term kidney survival in IgA nephropathy with particular emphasis on Oxford classification; A narrative review

Lisa Aimee Hechanova 1, Muhammed Mubarak 2 ORCID logo, Dorsa Jahangiri 3 ORCID logo, Jorge Bilbao 4, Leila Mostafavi 5 ORCID logo, Tella Sadighpour 6,7 ORCID logo, Ramin Tolouian 8* ORCID logo

1 Division of Nephrology, Department of Internal Medicine, Texas Tech University Health Science Center at El Paso, El Paso, TX, USA
2 Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
3 Independent Researcher, 43185 Cardston Place Leesburg Virginia, 20176, USA
4 Department of Pathology, Texas Tech University Health Science Center at El Paso, El Paso, TX, USA
5 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
6 American University of Antigua College of Medicine, Antigua and Barbuda
7 Herbert Wertheim College of Medicine, Florida International University, Florida, USA
8 Division of Nephrology, Southern Arizona VA Health Care System and University of Arizona College of Medicine, Tucson, Arizona, USA
*Corresponding Author: Corresponding author: Ramin Tolouian, Email: , Email: tolouian@arizona.edu

Abstract

Introduction: IgA nephropathy (IgAN) is one of the most common forms of glomerulonephritis worldwide. It leads to end-stage renal disease (ESRD) in many patients. At the time of diagnosis, risk stratification is of paramount importance in planning proper management in individual cases. Several studies have been conducted to determine the utility of various demographic, clinical, laboratory, and pathological features on renal biopsy to stratify the risk of disease progression and predict the likely outcome. This review summarizes the emerging data on demographic, clinical, laboratory, and histological prognosis along with risk factors associated with renal outcomes in patients with IgAN.

Methods: For this review, we searched DOAJ (Directory of Open Access Journals), PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar, using keywords including; “IgA nephropathy,” “IgA nephritis,” “IgAN,” “Berger’s disease,” “Berger’s syndrome,” “chronic glomerulonephritis, “prognostic factors,” “risk factors,” “risk stratification,” “renal survival,” “ESRD,” “MEST classification,” “MEST-C classification” and “Oxford Classification.” To identify other relevant studies, we manually scanned the bibliographic lists of the identified studies and reviewed articles from January 2009 through December 2020. All relevant articles were carefully reviewed, and relevant information was extracted for this narrative review.

Results: A total of 152 articles were retrieved from the above literature database searches. The abstracts were carefully reviewed to identify 35 articles containing information on prognostic factors and long-term renal survival in IgAN patients. Relevant information was collected and summarized for this review. The main focus was on using demographic, clinical, and laboratory features, especially serial changes in these parameters during follow-up, for this purpose. Recently a standardized, evidence-based formulation has been devised to evaluate and categorize pathological features on renal biopsy to augment and refine the risk stratification and prognostic value of traditional risk factors; it is popularly known as the Oxford classification of IgAN. There have been numerous validation studies in various ethnic groups that have proven its clinical utility.

Conclusion: In conclusion, the clinicians should also take into account the pathologic variables according to the revised Oxford classification in addition to demographic, clinical, and laboratory parameters for early and reliable risk stratification and prognostication in individual patients at the time of diagnosis in IgAN for optimal management and ultimate improvement in long-term outcomes.


Implication for health policy/practice/research/medical education:

Clinicians should take into account the pathologic variables according to the revised Oxford classification for early, accurate and reliable prognostication in individual patients at the time of diagnosis of IgA nephropathy.

Please cite this paper as: Hechanova LA, Mubarak M, Jahangiri D, Bilbao J, Mostafavi L, Sadighpour T, Tolouian R. Risk stratification and long-term kidney survival in IgA nephropathy with particular emphasis on Oxford classification; A narrative review. J Nephropathol. 2022;11(4):e18395. DOI: 10.34172/jnp.2022.18395.

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Submitted: 10 Jun 2022
Accepted: 13 Jul 2022
ePublished: 20 Jul 2022
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