A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy
IntroductionThis study aimed to investigate the relationship between Oxford Classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy (IgAN).MethodsThe study was a single-center retrospective cohort study involving 358 patients with primary IgAN who...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.890900/full |
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| author | Ri-Cong Xu Ri-Cong Xu Jian-Ying Guo Jian-Ying Guo Tao Cao Tao Cao Yi Xu Yi Xu Ying Liao Ying Liao Yu-Na Chen Yu-Na Chen Hai-Ying Song Hai-Ying Song Xiao-Jie Chen Xiao-Jie Chen Mi-Jie Guan Mi-Jie Guan Fei Tang Fei Tang Qiong Xiang Qiong Xiang Xing-Lin Chen Qi-Jun Wan Qi-Jun Wan |
| author_facet | Ri-Cong Xu Ri-Cong Xu Jian-Ying Guo Jian-Ying Guo Tao Cao Tao Cao Yi Xu Yi Xu Ying Liao Ying Liao Yu-Na Chen Yu-Na Chen Hai-Ying Song Hai-Ying Song Xiao-Jie Chen Xiao-Jie Chen Mi-Jie Guan Mi-Jie Guan Fei Tang Fei Tang Qiong Xiang Qiong Xiang Xing-Lin Chen Qi-Jun Wan Qi-Jun Wan |
| author_sort | Ri-Cong Xu |
| collection | DOAJ |
| description | IntroductionThis study aimed to investigate the relationship between Oxford Classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy (IgAN).MethodsThe study was a single-center retrospective cohort study involving 358 patients with primary IgAN who were treated at the Shenzhen Second People’s Hospital, China, between January 2011 and May 2021. Multivariate linear regression and generalized additive mixed models (GAMMs), adjusted for traditional risk confounders, were used to evaluate the correlation between scores for mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T), and crescents (C) (known as the Oxford Classification MEST-C score system), with proteinuria/creatinine ratio (PCR) at the time of renal biopsy and longitudinal changes in PCR, respectively.ResultsThe median PCR was 1061 mg/g, and it increased on average by 68.82 mg/g per year in these patients. Among patients with renal insufficiency, compared with patients without relative lesions, those with E present (E1) (1153.44; 95% confidence interval [CI], 188.99–2117.89 mg/g) and C > 0 (C1/2) (1063.58; 95% CI, 185.25–1941.90 mg/g) were associated with increased PCR levels at the time of renal biopsy. What’s more, S present (S1) (194.96; 95% CI, 54.50–335.43 mg/g per year) was associated with the fastest PCR increase; C > 0 (C1/2) (147.59; 95% CI, 8.32–286.86 mg/g per year) and T >25% (T1/2) (77.04; 95% CI, 7.18–146.89 mg/g per year), were also correlated with a faster PCR increase. In patients with normal kidney function, associations between S1 (55.46; 95% CI, 8.93–101.99 mg/g per year) and E1 (94.02; 95% CI, 21.47–166.58 mg/g per year) and PCR change could be observed. Additionally, in patients with overweight/obesity, S1 (156.09; 95% CI, 52.41–259.77 mg/g per year), E1 (143.34; 95% CI, 35.30–251.38 mg/g per year), T1/2 (116.04; 95% CI, 22.58–209.51 mg/g per year), as well as C1/2 (134.03; 95% CI, 41.73–226.32 mg/g per year) were associated with noticeably quicker PCR increase.ConclusionsOverall, E1 and C1/2 were independently associated with raised proteinuria levels at the time of renal biopsy, and S1, E1, T1/2, C1/2 were independently associated with a longitudinal increase in proteinuria in the patients with IgAN, especially in those with renal insufficiency or overweight/obesity, suggesting that currently available treatments might not be satisfactory, and weight control might be beneficial. Individual therapy development might benefit from the use of the Oxford Classification system. |
| first_indexed | 2024-04-10T23:50:50Z |
| format | Article |
| id | doaj.art-f950615ff850498fae226f7ac82b194c |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
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| last_indexed | 2024-04-10T23:50:50Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-f950615ff850498fae226f7ac82b194c2023-01-10T19:35:40ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-01-011310.3389/fendo.2022.890900890900A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathyRi-Cong Xu0Ri-Cong Xu1Jian-Ying Guo2Jian-Ying Guo3Tao Cao4Tao Cao5Yi Xu6Yi Xu7Ying Liao8Ying Liao9Yu-Na Chen10Yu-Na Chen11Hai-Ying Song12Hai-Ying Song13Xiao-Jie Chen14Xiao-Jie Chen15Mi-Jie Guan16Mi-Jie Guan17Fei Tang18Fei Tang19Qiong Xiang20Qiong Xiang21Xing-Lin Chen22Qi-Jun Wan23Qi-Jun Wan24Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaDepartment of Epidemiology and Biostatistics, Empower U, X&Y solutions Inc., Boston, MA, United StatesDepartment of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, ChinaDepartment of Nephrology, The Second People's Hospital of Shenzhen, Shenzhen, ChinaIntroductionThis study aimed to investigate the relationship between Oxford Classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy (IgAN).MethodsThe study was a single-center retrospective cohort study involving 358 patients with primary IgAN who were treated at the Shenzhen Second People’s Hospital, China, between January 2011 and May 2021. Multivariate linear regression and generalized additive mixed models (GAMMs), adjusted for traditional risk confounders, were used to evaluate the correlation between scores for mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T), and crescents (C) (known as the Oxford Classification MEST-C score system), with proteinuria/creatinine ratio (PCR) at the time of renal biopsy and longitudinal changes in PCR, respectively.ResultsThe median PCR was 1061 mg/g, and it increased on average by 68.82 mg/g per year in these patients. Among patients with renal insufficiency, compared with patients without relative lesions, those with E present (E1) (1153.44; 95% confidence interval [CI], 188.99–2117.89 mg/g) and C > 0 (C1/2) (1063.58; 95% CI, 185.25–1941.90 mg/g) were associated with increased PCR levels at the time of renal biopsy. What’s more, S present (S1) (194.96; 95% CI, 54.50–335.43 mg/g per year) was associated with the fastest PCR increase; C > 0 (C1/2) (147.59; 95% CI, 8.32–286.86 mg/g per year) and T >25% (T1/2) (77.04; 95% CI, 7.18–146.89 mg/g per year), were also correlated with a faster PCR increase. In patients with normal kidney function, associations between S1 (55.46; 95% CI, 8.93–101.99 mg/g per year) and E1 (94.02; 95% CI, 21.47–166.58 mg/g per year) and PCR change could be observed. Additionally, in patients with overweight/obesity, S1 (156.09; 95% CI, 52.41–259.77 mg/g per year), E1 (143.34; 95% CI, 35.30–251.38 mg/g per year), T1/2 (116.04; 95% CI, 22.58–209.51 mg/g per year), as well as C1/2 (134.03; 95% CI, 41.73–226.32 mg/g per year) were associated with noticeably quicker PCR increase.ConclusionsOverall, E1 and C1/2 were independently associated with raised proteinuria levels at the time of renal biopsy, and S1, E1, T1/2, C1/2 were independently associated with a longitudinal increase in proteinuria in the patients with IgAN, especially in those with renal insufficiency or overweight/obesity, suggesting that currently available treatments might not be satisfactory, and weight control might be beneficial. Individual therapy development might benefit from the use of the Oxford Classification system.https://www.frontiersin.org/articles/10.3389/fendo.2022.890900/fullIgA nephropathyOxford classificationproteinuria/creatinine ratiomixed methodsrenal function |
| spellingShingle | Ri-Cong Xu Ri-Cong Xu Jian-Ying Guo Jian-Ying Guo Tao Cao Tao Cao Yi Xu Yi Xu Ying Liao Ying Liao Yu-Na Chen Yu-Na Chen Hai-Ying Song Hai-Ying Song Xiao-Jie Chen Xiao-Jie Chen Mi-Jie Guan Mi-Jie Guan Fei Tang Fei Tang Qiong Xiang Qiong Xiang Xing-Lin Chen Qi-Jun Wan Qi-Jun Wan A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy Frontiers in Endocrinology IgA nephropathy Oxford classification proteinuria/creatinine ratio mixed methods renal function |
| title | A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy |
| title_full | A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy |
| title_fullStr | A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy |
| title_full_unstemmed | A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy |
| title_short | A mixed-method evaluation of the relationship between Oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin A nephropathy |
| title_sort | mixed method evaluation of the relationship between oxford classification scores and longitudinal changes in proteinuria in patients with immunoglobulin a nephropathy |
| topic | IgA nephropathy Oxford classification proteinuria/creatinine ratio mixed methods renal function |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.890900/full |
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