Indian J Pathol Microbiol. 2025 Jun 7. doi: 10.4103/ijpm.ijpm_217_24. Online ahead of print.
ABSTRACT
OBJECTIVES: 1) To perform a retrospective histological evaluation of renal allograft biopsies diagnosed as recurrent/denovo IgA nephropathy from January 2011 to January 2019 and calculate individual MESTC scores and Banff scores for all cases. 2) To perform clinicopathological and statistical evaluation of histological variables of the updated oxford scoring system with variables of estimated glomerular filtration rate, proteinuria, and serum creatinine, recorded at the time of the last follow-up.
MATERIALS AND METHODS: This was a retrospective cohort study conducted at a tertiary hospital. 53 cases of IgA nephropathy were selected including 11 cases of recurrent disease and 42 cases which arose denovo, including those with unknown native kidney disease. The updated oxford score and Banff criteria were applied to all cases and correlated with clinical data and transplantation details available from the online database using univariate and multivariate analysis. Statistical analysis was done using STATA version 16.0.
RESULTS: Patients with interstitial fibrosis/tubular atrophy were associated with significantly higher creatinine, proteinuria, and lower eGFRs at the time of biopsy. Cox hazard ratio showed that patients with interstitial fibrosis/tubular atrophy had a significantly higher chance of progressing to end-stage kidney disease. Patients with either endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, or multiple lesions also progressed significantly faster to end-stage kidney disease.
CONCLUSION: Interstitial fibrosis/tubular atrophy and segmental sclerosis were indicators of poor graft survival. Patients with combined lesions, particularly chronic lesions progress significantly faster to end-stage kidney disease. Patients with endocapillary hypercellularity had improved outcomes when treated with adequate immunosuppression. We conclude that the updated oxford classification be used for prognostication in addition to the Banff criteria being already in use.
PMID:40485360 | DOI:10.4103/ijpm.ijpm_217_24
