Endocapillary hypercellularity and crescents are associated with lower renal survival and more rapid loss of renal function in patients not receiving immunosuppression, whereas crescents in at least 25% of glomeruli predict lower renal survival irrespective of treatment; a C score has been added to the MEST scores in the 2016 revision of the classification.
While glomerular CD68-positive cells emerge as markers of endocapillary hypercellularity, their tubulointerstitial counterparts are associated with chronic damage.
Digital image analysis revealed that tubulointerstitial CD68-positive cells correlated moderately with % TA/IF (r = 0.59, r<sup>2</sup> = 0.35, P < 0.001) and GFR at the time of biopsy (r = 0.54, r<sup>2</sup> = 0.29, P < 0.0001), but not with mesangial and endocapillary hypercellularity.
The proportions of patients with preserved renal function and acute-stage inflammatory histologic changes (i.e. endocapillary hypercellularity and extracapillary proliferation) at the timing of biopsy increased over time, as did the rates of prescriptions of renin-angiotensin system blockers and corticosteroids (all P for trend <0.05).
Plasma ADAMTS-13 activity was negatively associated with total pathological AI scores ( r = -0.326, p < 0.001), endocapillary hypercellularity ( r = -0.419, p < 0.001), cellular crescents ( r = -0.274, p < 0.001), subendothelial hyaline deposits ( r = -0.266, p = 0.001), interstitial inflammatory cell infiltration ( r = -0.304, P < 0.001), tubular atrophy ( r = -0.199, p = 0.011), acute glomerular vascular lesions ( r = -0.344, p < 0.001) and acute renal vascular lesions ( r = -0.338, p < 0.001).
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).