A Novel Scoring System Based on Oxford Classification Indicating Steroid Therapy Use for IgA Nephropathy
Shusaku Itami, Takahito Moriyama, Yoei Miyabe, Kazunori Karasawa, Kosaku Nitta
Abstract
IntroductionThe usefulness of the Oxford classification (MEST-C score) for deciding the management approach for IgA nephropathy (IgAN) remains unclear.MethodsEffects of steroid therapy on the long-term prognosis for all 858 patients with IgAN and patients classified according to each MEST-C score were evaluated using Kaplan-Meier and Cox regression analyses. Steroid responder score (SRS) and steroid nonresponder score (SNRS) were determined using individual pathology scores when steroids were found to be independently associated, or not, with clinical benefits. In addition, the effects of steroid therapy according to the total SRS/SNRS were analyzed.ResultsSteroid therapy improved the 20-year renal survival rates of patients with IgAN after matching (steroids[+] vs. steroids[−]; estimated glomerular filtration rate [eGFR] [ml/min per 1.73 m2]: 79.4 vs. 77.0, not significant; proteinuria [g/d]: 0.80 vs. 0.62, not significant; renal survival rate: 75.5% vs. 61.7%; P = 0.025) and of patients with M1, E1, S1, C1+2, and T0 scores. Therefore, we considered the total of the M1, E1, S1, and C1+2 scores (point 0: low, 1–2: medium, and 3–4: high) as the SRS and the total of the T1+2 scores (0: low and 1: high) as the SNRS. Multivariate Cox regression analyses revealed that steroid therapy improved the renal prognosis of patients with IgAN with high SRS and any SNRS, unlike patients with IgAN with medium SRS and any SNRS.ConclusionPatients with M1, E1, S1, and C1+2 scores responded to steroid therapy; however, those with T1+2 scores did not. Although a high SRS was a useful indicator for steroid therapy, SNRS indicated resistance to steroid therapy.