meeting report Oxford Classification of IgA nephropathy 2016: Devons an update from the IgA Nephropathy Classification Working Group Heinén Tuiarch Jonathan Barat Daniel C. Catan’, H. Terence Cook’, Rosanna Coppa Mark Haas’, Zhitiong Liu’, lan SD. Roberts", Yukio Yuzawa’, Hong Zhang" and John Feehally? on behalf of the IgAN Classification Working Group ofthe international Iga Nephropathy Network and the Renal Pathology Society’; for Conference Participants ‘nga atc de or Aes Ageing “Oat fet go “Deperoen oF Med Teo Gera Research ee, Unesty Heath Heo Toran Genre Tara nfm Cana ‘cnte for Carlene ond ntancn hes apart of Me npr Coleg, Londen ted igor Foazore Raa Maer Mepelagy, Dax and rotartton hao Matha Hea Rana ‘Deparment o Paoloy and atevatey Nese, Cea Sa! ssl Cre Los Angst CoM USN Deprt (Neh, Nana! Cl Cant ney Dare Sng total AaningUnvestySo f dine, Nang, Cn “Seer of cy eto rd ey ah di gs gat py it sh Since the Oxford Claafeation of IgA naptvophy AN sh files hve contre that in bopoy specimens th 2 rina of 8 lomeru, mesangial perl ‘Segmental cero (Sa inter Sree Sy, crescent (ate rate of autcome, ane we no ‘recommend that Ce ed tthe MEST score, and Bonny T oxo Cation th np trorking grou of ephrlogists and real path Network andthe Renal Pathalogy Sots" The tc. tan ns ase on abet evidence developed ins cbr cation indicated that there were only 3 reproducible ‘aru seen on the cl bipey in AN tht indepen Aken predicted outcome and povided proppantc sor ‘mation in addon to. progoous pedi yhen by Iyperellrity (M),sogmentalpomerulclero (8) Ad tubular stophyitrstl Sores CT), In ado, tog patients ith endocaplary hyperelarty( the rte a eal funtoal dele wap igen lowe In thee resiving orev therapy. The Oxford asian thus icudes these 4 parameters, the MEST “Since 209, the easton has ben widely adopted in apa in a ey oe Piacoa eat, lrgelyeeplacing oer presoaty pple se tm efor fans guna mat aftion tht werent aly evidence end A ur of cranes Stes hae soght to ale the predic vac of MES "so Appt ote camtuing member he Wong exe acre in ater me incase retnpie cts This hs Acted # Onc 2016 rend 10 Juny 2017, weil 2 ined demonstrating the ae ofthe Ono Casein ‘Ste 207 pate one en 207 Predicting. longtmeotcomes of Meno Shae ‘eportng soul provide» MEST score. Inconatences the eporing of Mand endcalny elisa (2 Tesons {38 pathologie has been developed A lrg sy Showed E esos are presictve of atcome in ern and ‘us, but onlin has thou mnosuperesion A ‘even of leson age thre may be cn uty fe ‘he subeesefaton of rgmenta cero Menying ‘hose cases th evidence of podocyteaamage hse now been shown tha combining the MES sore wth ina stat bopy provides the same preicve power se ‘monorng cil data for 2 years ths reqs farther Wel-caraeze data rom sarge cohort fat an ‘hen with Wg that wl roid a abate for fothar tutes to reine rk prediction and cal uly, cudng the MEST acre ane ater factors,i it gd vcs) a wel IAN? oh in of cial anges wih he MEST soe to proc Prego acarcy. The og waking gu wi sate fener mestings inching anater in Oxford in 2014 and ts exblbed scbgrups tha foc ond ean Ite aso ut wong sib. We make rer se propre nna work ht wil apron sl fhe the ali ofthe caon in tsar and in cli the onal Oxford sd eaost was htt cluded only 265 adults and children, and only those of “ie Causa hom Europe nd North Ameri ap Eat proteinuria {1 abo excluded those with an estimated [omer fein rte (GER) <0 ran per 3m th the itent of wong the sleson of sry aan ‘lm spy progressive case 8 which crescent ight more Tl be pred of outcome, Stace 208, mmrous studies hve been published tht ‘lies, ahough none prospectively sted ew cohorts newt they provi vale coborsive endence Sinem such sas’ ining cohort fiom Europe [ed tht inde core fom an an ad th Koren Al thee sud te samarizd i Sappementaty Table at MS, aT Ter ach elaiy prvi progmonic rere oie, inpendet pedo fen outcome report emer i tan Seu Chble 1) Howeve the orga Oxford Clsiaton eal teams Although tee Bindings donot is themsees the rgasizaon of sgmesal netting or endocpibry fodecyte hypertophy or sleross at the tubular pale (GP frit, aing St only for scrote lions with podcytopathcmeeting report 1 eareting Oxford MEST params with nica automa gh nephropathy (minimum cohort ana 4 maineo to BE Ewe Adon ptologi fates considered fr nk Oxford cnaeston tno gra A potion. The Oxon Clas cation wan devloped ang hgh mcoscpi nang ony Diker ports hie suggested that the prec of 6 don pando te oetion of eh ae peice of fowowe, for samp that sloere splary wal {ipenite may cay 2 ne prognosis than serge Tools sone Home, ele of te OnfordClasifeaton ‘horse show tht ahough the pen of gomerar {a6 an capillay wall Iga depose (ented by in ouoesence or inmanshisochensty) ate asocted With worse sucoms, they do no ada predictive au to Oxford sty! ad se ‘eS cen wernt ound to best independent preior f wl ontceres However nds ih eee Teal pinent sumated UR CSD npr 173 0) ‘rec autinfued in tho stad, and Katich oa und Tove ote pete ERD 256 AN pet not ‘Rov tio fuel epi of por ral tomes Toeed her auth ung pac whan eine Gir ead mda per 73 "Avr saga he asa poten prin fre tare fn IgAN in apo ho of 36 patents smb fom 4 rewopetie Teste {fom chia” and sot om aun The working SShetop stdial stone Between the proportion of [omer contin cell or bac escent the Fae ver uncon deine aed uri of 0% denen ‘al funtion or ESRD cad ent whe nating fr In ths combined ebor including bps specimens with minima of 8 lel equ fors MEST cre the prem o eiets ws svongly sted wih subseert Ee af inmunonpresion Oneal, cen were Ine pendently prediive of higher rik of combina erent {rd na137, 95% cohen ftera 107-175). Tae tion tein saitly sient only is ose ens nk didnt rseie immnosappeein, Thee was Eo proportion dependent reltonp berms the fe te Lie and =i omer he haar ao of com Ve eet nsened o 1 95% conidence ntl 110- tira nrg he ek of combined enone assoc ot wih ceeas in 229% of poner romined “st cing awe| 1 | : ; i i j { i | i i ‘ i | | 1 ne kings ofthis king roup support the aden of coset score (Ch ly andC2) tothe Oxford MEST aieow 0 cl of omer 1 agniseay Higher ries poor seal outcome han sents whose poy pein ad a cece (0) a) Por weaed wih Inmunosippresion bat ot if ete Feeomatenation that those with C1 eone shuld be trecenisin>2596 of ler further Wenn pte at kof poor real tte even ued wa imo ‘spore Thxfr, we prope th the Ox 2Ete should now inate components MEST-C ther fn iced in his abort so aot ot poe Tonfie wheher cece have sar signa i hat ‘ranaton of someutr macrophages. It bas be {Coat wen glomerae sacopages ight st athe rcopation of El leone and be poenaly superior to smiownasuperesson and in who El wae am independent preictoe of the rate of or of renal futon ad ea ‘cal In these py spximens, quate aa of Detadic ad-Schth staid sections, but oot MS. of T See Unga ctf of marin glomerular mrp sor in 8% of Dlosy tbe determined whether glomerular macrophage ects tee sper clnlvaletoE sing. ‘hen The alton sues chien younge thn eto ag fom ip China "and Swede ad he no India etre matin an independent preitive ‘ale, apart Goan leon i pease Chine paint This wt Lye tothe tinted numberof lens ching end pois In sje 23 year fae OF Younger ‘ve by makita or sure om combed ‘thet certs, signiicant predictive values for some scores ny Mf and 1) were found in odel ndodng ‘Usa dt renal lop. The tot power pete meeting report ell ee ana i MIL Ia the Japanese cast the presence of exes in > gomeru wa signa generate large database for children with TAN sn onder {oso the probler of inadt taiial power de 1 ftvall numbers of progres cass spec wt eatey TAN are to improve the progoosic infor in vidual pao and eesti cei for i rl Ee prediction alors sought to sepa cial Ending presentation andor tne with real palo tine On nia snl ny nal and polo tlemene were tleant to outcomes, hit marine ‘er time” The maximum peice power to expat a Ibis in outcome in any patent was only aaa when fob, the North Americas validation stay and the VALIGA study The previous prediction lori ung Sei caret pradicion smodd sta approach The Frediaive jumer af that orignal agin wat then onpure wth he pret purer he MEST coe sone Sod is priced outcome and the 2 year dies! data alae ‘eth conparsblecllbaon curves Tis eit dd not Sing whe amis hone wn nee ff the MEST sore was auld. Mewngial bypereslity “screed the Mod of rl sural fom 90% 0) (-component MEST-C ‘were excladed from the eecent study of crescents in AN,” wre veered the MEST score oot be api to ete Uf anh Scio papa ep The denon fo exch component inthe Oxon Chas Caton wee the rk ofan rte roc ivabing the fel ptologit in th rg oki gro: Deion tree rien to be staighonaré and to masini te Uainod tut patolgats would beable 0 conser ey he ess in casa pace, However a aubsuen ‘Sntences ta dentfietoa of M and Eledont Loc Patlogs dagnod Mice a en athe cena ve Pathlegt and E13 tine aren. The M cre en by the ml ut ot the Ic bog masa dependent pedir of real steam. To bp enero th hed tal ha en eloped topside emp of ‘eh eon ad asst paolo to oreteme the emnealy “ate 2| commendations for updating the Oxord auiacaton orga Nosh rp ps gh ‘ale 2 Recommendations fo h na ie ‘esha (updo rm te 2 ana 2) The Hl tng ie ei ton be aulableom the Repl PaaogySocety Website sey acre toga Ox Cla ‘etal clinica and putolog data tha lbwed ws 0 ‘Maes the questions post The mtemaonalclaborive ‘orth othe orginal Old Csieaton contin tnd ve ae cueny urblng 4 core fom mule “America The objective to develop a cohort representing the fl pcr of ies sec ing AN wh no tations fon ploenui r teal fanton. Tes echort wl Be repre ‘Soave of wide ang of ante county, pater of Pave, and ope ta chartered Wy dep patent level stg lng lw up sols enable aening ove qusinns thet xe not poble sing sale b {tse Approsimatsy 000 such patent dats tht ininde cen and ada have be lee nd pre Titay alas seen pao” Thi core wl be vel salvrte for fre tes i TAN to prone bacene podison for india! puieets and reine ‘rumen and outcome cts for dina ea The et tray purpose wl else a resition model in gAN {Gtalogh tte Famingbam peeicton re for cada Naseer diese) tm ito, we expec that th cor wl be datasource or ther tds nciing the pentvss information through ln and paolo fe fhe impronng sagas ae eatcton terapy sec fon, precios of sepome to. theapy, and ik erplnation recurene, With the coninod va fone of pte "biome" in the erm, pars, ine, to ey, However IAN, there te esc rar ois and thse lack nigoous prospective raat In finest poplaions™ Vara calecion and srg of Tioga mpl for biomarker ane cn be gant fuer ih anaes, Underlconted sere e§ ‘Sc cations to hat gh Bae ee staid nd may be of be for predicting ropes rk td planation rere Blmarets have the prea fo impne region of ESRD, to at the lin in romping india potent and to dee surat ead Fein the cuaton of cia ile To maximize he Sopot eingcrestedby he described age eration THAN cory emmendations wil be aged on and pub reporting 6 to develop an additional cellular: marker for ‘ln pct bate it prov spe meeting report rom ont wi rerouted to determine teva ofthe MEST score and selection of hoy It his ave Yen intend tha he Osford Chacon oud be sje tse wn depdermen tt bk ‘Seemblethe original Ord coor of only 255 beet, The ‘egal cbort was cached with soy prope TgAN cacy thus maxing te chines of ontpng sigan Sal enor Father dts om te ons Smear ere td eee!" endorse the contin the ofthe MEST acon These dl lo provide dence af the precive vie of a © stre ACL sure (cme (Groce in 255 of hel ter ene patent fh a por anal ouone een teed th mana fmppmaton” Immnosuppesnive egy fs en sed to suppor th approach is only aecdota- Although i sil [remitted our bsereton 4 ating thew [muncsuppeesion when C1 leans at ound thi sould be uveigied further n randomized. clise re 10 ‘icine whether spec wement recommendations “Anthea roe fr the MEST-C sor inepeting pet eal bop in AN, The are catty ommewaions can caret be male athough the sly ‘Roe imoranonppreive emet decreas Sgieaty n poavsonent bp, Sipiiant ntona bereft ofthe development of he topes share dtaandblampley and to der ‘cleric pec aot anil by cach inetigtor Srrking. with smaller cohorts This nebo as now tay bel tn demnprie arctic ned [hemsyying and outcome epetng topo the tre For ftre sais incding soa of novel iors [ied unbers prove a cheng othe sof GAN ‘lle ths cohort arose thi be By ing 1000 SN summary, we propose an etenson of the MEST sc in the Ord Cascio af IgAN to become a MEST-C Sore for tue in sting lial patie and rescch. In tion uo providing the cadence Base to endo this ‘reonmenation te coining crs of ou gro Bae rds ebook to fiat he ser of» Lge igo tehort of welcome wilh GAN, providing esing te pathogens pido and lal catemesting report Norte acon hen ope a ‘Sure fn rr gaye npr es Stents ml ished te nie vere te erat ‘pron i rn 8 sce Sh on