Clinicopathological features of IgA nephropathy in children and adults assessed by the Oxford classification and glomerular crescent lesion typing

Bai Qiu-yu; Yang Xiao-qing; Dong Li-wen; Liu Meng-meng; Xie Ge-ge; Huang Yan-jie

doi:10.3969/j.issn.1671-2390.2025.03.005

Journal of Clinical Nephrology > 2025 > 25(3): 208-214. > DOI: 10.3969/j.issn.1671-2390.2025.03.005

Bai Qiu-yu, Yang Xiao-qing, Dong Li-wen, Liu Meng-meng, Xie Ge-ge, Huang Yan-jie. Clinicopathological features of IgA nephropathy in children and adults assessed by the Oxford classification and glomerular crescent lesion typing[J]. Journal of Clinical Nephrology, 2025, 25(3): 208-214. DOI: 10.3969/j.issn.1671-2390.2025.03.005

Citation:

PDF (7727 KB)

Clinicopathological features of IgA nephropathy in children and adults assessed by the Oxford classification and glomerular crescent lesion typing

1. Pediatric Hospital, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China;
2. College of Pediatrics, Henan University of Chinese Medicine, Zhengzhou 450046, China;
3. Department of Traditional Chinese Medicine, Shanghai Children's Hospital & Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China

Funds:

General Program of National Natural Science Foundation of China in 2021 （82174187）；leading talents of science and technology innovation in Zhongyuan（234200510028）； Leading Talent Project of Traditional Chinese Medicine in Henan Province[No.（2021） No.8]

More Information

Received Date: April 26, 2024

Graphical Abstract

Abstract

Abstract

Objective To clarify the clinicopathological features of immunoglobulin A nephropathy（IgAN） in children and adults by categorizing crescentic lesions into cellular crescents, fibrocellular crescents and fibrous crescents based on the Oxford classification. Methods Clinicopathological data of 168 cases of pediatric IgAN（children group） and 381 cases of adult IgAN pathologically confirmed by renal biopsy between January 1, 2012 and December 31, 2022 in the First Affiliated Hospital of Henan University of Chinese Medicine were retrospectively collected. Adult IgAN patients were subdivided into the youth group and the middle-aged and older adult group. The differences and correlations of clinical classification and pathological indexes among children group, youth group and middle-aged and older adult group were compared. Results The statistical results of clinical classification in the three groups showed that the proportion of nephrotic syndrome type（37.50% vs 11.99% vs 11.24%,63 cases vs 35 cases vs 10 cases）in the children group was significantly higher than that of the youth group and the middle-aged and older adult group（P<0.05）. The proportion of hematuria with proteinuria（43.49% vs 32.74% vs 29.21%,127 cases vs 55 cases vs 26 cases）was significantly higher in the youth group than that of the children group and the middle-aged and older adult group （P<0.05）. The proportion of chronic nephritis type（53.93% vs 4.17% vs 37.67%,48 cases vs 7 cases vs 110 cases）was significantly higher in the middle-aged and older adult group than that of the children group and the youth group （P<0.05）. According to the Oxford classification, significantly higher proportions of glomerular mesangial cell proliferation （76.19% vs 60.37%,128 cases vs 230 cases）, endothelial cell hyperplasia （45.83% vs 13.65%,77 cases vs 52 cases） and cellular crescent （50.00% vs 30.71%,84 cases vs 117 cases） were seen in the children group than the remaining two groups, and significantly higher proportions of glomerular segmental sclerosis（69.82% vs 44.64%,266 cases vs 75 cases）,fibrous crescents （18.90% vs 8.93%,72 cases vs 15 cases）, tubular atrophy and interstitial fibrosis （29.40% vs 2.39%,112 cases vs 4 cases） were seen in the youth group and the middle-aged and older adult group than the children group （P<0.05）. The 24 h urine protein quantification was moderately positively correlated with the percentage of cellular crescent, percentage of total cellular crescent and fibrocellular crescent, and percentage of endothelial cellular hyperplasia （r= 0.65,r= 0.56,and r= 0.41,respectively； P<0.05）. The estimated glomerular filtration rate （eGFR） was moderately negatively correlated with renal tubular atrophy/interstitial fibrosis （r= -0.61,P<0.05）.ConclusionsPediatric IgAN is dominated by acute glomerular lesions, and the nephrotic syndrome type is the main clinical type. Chronic glomerular, tubulointerstitial and vascular lesions in adults are the pathological basis for the formation of the chronic nephritis type. Cellular crescents, fibrocellular crescents and fibrous crescents were scored respectively in the Oxford classification is more clinically instructive.
- Child,
- Adults,
- IgA nephropathy,
- Crescent

FullText(HTML)

References (25)

References

[1]	Gan T, Li Y, Zhou XJ, et al. Immunoproteasome in IgA nephropathy: state-of-art and future perspectives[J]. Int J Biol Sci, 2020, 16(14): 2518-2526. DOI: 10.7150/ijbs.48330.
[2]	Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13, 519 renal biopsies[J]. Kidney Int, 2004, 66(3): 920-923. DOI: 10.1111/j.1523-1755.2004.00837.x.
[3]	乐伟波, 梁少珊, 邓康平, 等. 1126例中国汉族成人IgA肾病患者的长期预后及危险因素分析[J]. 肾脏病与透析肾移植杂志, 2011, 20(2): 101-108. DOI: 10.3969/j.issn. 1006-298X.2011.02.001. Le WB, Liang SS, Deng KP, et al. Long-term renal survival and related risk factors of patients with IgA nephropathy: results from a cohort of 1 126 cases in a Chinese adult population[J]. J Nephrol Dialy Transplant, 2011, 20(2): 101-108. DOI:10.3969/j.issn. 1006-298X.2011.02.001.
[4]	Cambier A, Rabant M, El Karoui K, et al. Clinical and histological differences between adults and children in new onset IgA nephropathy[J]. Pediatr Nephrol, 2020, 35(10): 1897-1905. DOI: 10.1007/s00467-020-04614-3.
[5]	中华医学会儿科学分会肾脏学组. 原发性IgA肾病诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(9): 643-646. DOI: 10.3760/cma.j.issn.0578-1310.2017.09.002. The Subspecialty Group of Nephrology, Society of Pediatries, Chinese Medical Association.Evidence-based guidelines for diagnosis and treatment of primary IgA nephropathy(2016)[J]. Chin J Pediatr, 2017, 55(9): 643-646. DOI: 10.3760/cma.j.issn.0578-1310.2017.09.002.
[6]	Beck LH, Ayoub I, Caster D, et al. KDOQI US commentary on the 2021 KDIGO clinical practice guideline for the management of glomerular diseases[J]. Am J Kidney Dis, 2023, 82(2): 121-175. DOI: 10.1053/j.ajkd.2023.02.003.
[7]	Trimarchi H, Barratt J, Cattran DC, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group[J]. Kidney Int, 2017, 91(5): 1014-1021. DOI: 10.1016/j.kint.2017.02.003.
[8]	Mizerska-Wasiak M, Turczyn A, Such A, et al. IgA nephropathy in children: a multicenter study in Poland[J]. Adv Exp Med Biol, 2016, 952: 75-84. DOI: 10.1007/5584_2016_65.
[9]	全国儿童常见肾脏病诊治现状调研工作组. 中国儿童IgA肾病治疗现状多中心回顾性研究[J]. 中华儿科杂志, 2013, 51(7): 486-490. DOI: 10.3760/cma.j.issn. 0578-1310.2013.07.003. The national children's present situation of diagnosis and treatment of common kidney disease research group. Multicenter investigation of therapeutic status of children with IgA nephropathy in China[J]. Chin J Pediatr, 2013,51(7): 486-490. DOI: 10.3760/cma. j.issn.0578-1310.2013.07.003.
[10]	蒋小云, 陈述枚, 杨霁云, 等. 33所医院儿童原发性IgA肾病临床和病理表现调查分析[J]. 中华儿科杂志, 2007, 45(4): 272-278. DOI: 10.3760/j.issn:0578-1310. 2007.04.009. Jiang XY, Chen SM, Yang JY, et al. Clinical and pathological manifestations of Chinese childhood patients with primary IgA nephropathy:a national collaborative study of 33 hospitals[J]. Chin J Pediatr, 2007, 45(4): 272-278. DOI: 10.3760/j.issn: 0578-1310. 2007.04.009.
[11]	谢姗, 王娟, 江肖, 等. 肾活检1912例病理疾病谱与临床诊断相关性分析[J]. 临床与实验病理学杂志, 2020, 36(12): 1452-1455. DOI: 10.13315/j.cnki.cjcep.2020.12.016. Xie S, Wang J, Jiang X, et al. Correlation analysis between pathological spectrum and clinical diagnosis of 1912 cases of renal biopsy[J]. J Clin Exp Pathol, 2020, 36(12): 1452-1455. DOI: 10.13315/j.cnki.cjcep.2020.12.016.
[12]	陈洁欣, 汤睿莹, 梁波, 等. 554例IgA肾病患者临床特征分析[J]. 新医学, 2022, 53(6): 436-440. DOI: 10.3969/j.issn.0253-9802.2022.06.010. Chen JX, Tang RY, Liang B, et al. Analysis of clinical characteristics of 554 patients with IgA nephropathy[J]. JNM, 2022, 53(6): 436-440.DOI: 10.3969/j.issn.0253-9802.2022.06.010.
[13]	Cambier A, Rabant M, El Karoui K, et al. Clinical and histological differences between adults and children in new onset IgA nephropathy[J]. Pediatr Nephrol, 2020, 35(10): 1897-1905. DOI: 10.1007/s00467-020-04614-3.
[14]	Xu RC, Li ZJ, Cao T, et al. The association of the Oxford classification score with longitudinal estimated glomerular filtration rate decline in patients with immunoglobulin A nephropathy: a mixed-method study[J]. Int J Gen Med, 2021, 14: 2655-2663. DOI: 10.2147/IJGM.S313333.
[15]	Zhang XY, Shi SF, Ouyang Y, et al. A validation study of crescents in predicting ESRD in patients with IgA nephropathy[J]. J Transl Med, 2018, 16(1): 115. DOI: 10.1186/s12967-018-1488-5.
[16]	Ma F, Liu LM, Dong RJ, et al. Renal survival and risk factors in IgA nephropathy with crescents[J]. Int Urol Nephrol, 2020, 52(8): 1507-1516. DOI: 10.1007/s11255-020-02457-3.
[17]	Neves PDMM, Pinheiro RBB, Dias CB, et al. Renal outcomes in Brazilian patients with immunoglobulin A nephropathy and cellular crescentic lesions[J]. Kidney Blood Press Res, 2020, 45(3): 431-441. DOI: 10.1159/000507251.
[18]	Trimarchi H, Haas M, Coppo R. Crescents and IgA nephropathy: a delicate marriage[J]. J Clin Med, 2022, 11(13): 3569. DOI: 10.3390/jcm11133569.
[19]	Ma F, Liu LM, Dong RJ, et al. Renal survival and risk factors in IgA nephropathy with crescents[J]. Int Urol Nephrol, 2020, 52(8): 1507-1516. DOI: 10.1007/s11255-020-02457-3.
[20]	Delbet JD, Geslain G, Auger M, et al. Histological prognostic factors in children with Henoch-Schönlein purpura nephritis[J]. Pediatr Nephrol, 2020, 35(2): 313-320. DOI: 10.1007/s00467-019-04363-y.
[21]	王牡丹, 许菲菲, 苏震, 等. IgA肾病伴部分性新月体形成的临床病理分析[J]. 中国中西医结合肾病杂志, 2007, 8(4): 209-211. DOI: 10.3969/j.issn.1009-587X.2007.04.008. Wang MD, Xu FF, Su Z, et al. Clinicopathological analysis of IgA nephropathy with partial crescentic formation[J]. Chin J of Int Trad and West Nephro, 2007, 8(4): 209-211. DOI: 10.3969/j.issn.1009-587X.2007.04.008.
[22]	Zhang W, Zhou Q, Hong LY, et al. Clinical outcomes of IgA nephropathy patients with different proportions of crescents[J]. Medicine (Baltimore), 2017, 96(11): e6190. DOI: 10.1097/MD.0000000000006190.
[23]	Park S, Baek CH, Park SK, et al. Clinical significance of crescent formation in IgA nephropathy-a multicenter validation study[J]. Kidney Blood Press Res, 2019, 44(1): 22-32. DOI: 10.1159/000497808.
[24]	Zhang XY, Shi SF, Ouyang Y, et al. A validation study of crescents in predicting ESRD in patients with IgA nephropathy[J]. J Transl Med, 2018, 16(1): 115. DOI: 10.1186/s12967-018-1488-5.
[25]	Lee JH, Jang SH, Cho NJ, et al. Severity of foot process effacement is associated with proteinuria in patients with IgA nephropathy[J]. Kidney Res Clin Pract, 2020, 39(3): 295-304. DOI: 10.23876/j.krcp.20.017.

Cited By

Get Citation

PDF

XML

Article views (14) PDF downloads (1)

Turn off MathJax

Article Contents

Abstract

References

Clinicopathological features of IgA nephropathy in children and adults assessed by the Oxford classification and glomerular crescent lesion typing

Abstract

References

Catalog

Export File

Citation

Format

Content