Wednesday, April 27, 2011

NKF Spring Clinical Meeting - IgA

The NKF Spring Clinical meeting started today in Las Vegas. I thought I’d share of the interesting highlights from some of the talks I’ve attended. This post relates to Dr Appel’s lecture on IgA nephropathy, where he described the recent literature on pathogenesis and treatment and a relatively new classification system called the Oxford-MEST system.

This classification system was devised at an expert group meeting in England. Pathologists (blinded) retrospectively examined 265 biopsies from adult and paediatric patients with IgA, who had five-year follow up data available. The biopsies were scored on pathological variables and entered into a prediction system based on the follow-up data available. They came up with four features that were strongly predictive of renal outcomes:

M – mesangial hypercellularity; scored 0 or 1
E – endocapillary proliferation; scored 0 or 1
S – segmental glomerulosclerosis; scored 0 or 1
T – tubular atrophy/interstitial fibrosis; scored 0, 1 or 2

A notable absence in this classification system is presence of crescents – the reason why this is not included is simply that in the 265 samples they analyzed, there were too few samples with crescents to make any significant inference about.

Further validation of this score is ongoing in various samples, but it appears to be gaining recognition and popularity and is something we should be aware of.

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