The response of the Oxford classification to steroid in IgA nephropathy: a systematic review and meta-analysis
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Pingping Yang1,*, Xi Chen2,*, Lei Zeng3, Hua Hao3 and Gaosi Xu1
1Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
2Grade 2013, The Second Clinical Medical College of Nanchang University, Nanchang, China
3Department of Pathology, The Second Affiliated Hospital of Nanchang University, Nanchang,China
*These two authors contributed equally to this work
Gaosi Xu, email: email@example.com
Keywords: IgA nephropathy, Oxford classification, steroid, proteinuria
Received: January 18, 2017 Accepted: June 02, 2017 Published: July 26, 2017
Background: The present review is aimed to evaluate the correlation between pathological features and the response to steroid in the patients with IgA nephropathy according to the Oxford classification, mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy and interstitial fibrosis (T).
Methods: We searched Chinese Biomedical Database, EMBASE, Cochrane Library, PubMed and MEDLINE with all spellings of “IgA nephropathy”, “Oxford Classification”, and “steroid”.
Results: 5 studies with 637 patients were eligible for inclusion. The analysis showed that M1, S1, and T1/2 was strongly associated with the prediction to steroid resistance when compared with M0 [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.01 - 3.56, P < 0.05], S0 (OR 2.24, 95% CI 0.99 - 5.08, P = 0.05) and T0 (OR 2.16, 95% CI 1.29 - 3.63, P = 0.004) respectively. There is no difference in steroid sensitivity between E0 and E1 (P = 0.55). The pooled OR of steroid resistance for E1 versus T1/2 is 0.50 (P = 0.04).
Conclusion: IgA nephropathy patients with serious pathological changes (M1, S1, and T1/2) were more resistant to steroid than slight ones (M0, S0, and T0), and E1 is better response to steroid therapy than T1/2.
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