Correlation of Oxford Classification Score with Early Response to Treatment in IgA Nephropathy: A Cross-Sectional Study
Abstract
Objective: To evaluate correlation between the Oxford classification score and early response to treatment in Immunoglobulin A nephropathy (IgAN) in a single-center study in northern Pakistan.
Methods: This cross-sectional study was conducted at Department of Nephrology, Shifa International Hospital, Islamabad, from July 2024 to January 2025. Patients aged 18 to 65 years with biopsy-proven primary IgAN were included. Baseline demographic, clinical, and laboratory data, including serum creatinine, estimated Glomerular Filtration Rate (eGFR) and proteinuria, were recorded. Renal biopsies were assessed using the Oxford classification, evaluating mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C). Early treatment response was defined as a ≥50% reduction in proteinuria after three months.
Results: Of total 30 patients, the median age was 30.5 (24.5 – 43.5) years. The Oxford classification revealed that 19 (63.3%) patients had M1 and S1 lesions, 16 (53.3%) had E0 lesions, and 12 (40.0%) exhibited T0 lesions. A significant reduction in proteinuria was observed after treatment (p-value < 0.001), with eGFR and serum albumin levels improving significantly (p-value 0.003 and p-value 0.023) respectively. T1-2 lesions demonstrated a strong negative correlation with eGFR (ρ = -0.760, p-value < 0.001), E1 lesions were moderately correlated with proteinuria (ρ = 0.378, p-value 0.039). Treatment response was observed in 12 (40%) patients, but no significant associations were found with individual Oxford classification scores.
Conclusion: A significant reduction in proteinuria and improvement in eGFR and albumin observed post-treatment. Histopathological features correlated with renal outcomes, emphasizing significance in predicting early treatment outcomes.
Downloads
References
Jehanzeb K, Haq ZU, Shah SA, Lodhi MA, Ashraf N. Comparison of manifestations of giardia and Ascaris infestations between both genders presenting with diarrhea: Comparison of giardia and Ascaris infestations among children in GB. Pak Armed Forces Med J 2020; 70:1681-5. doi:10.51253/pafmj.v70i6.2798
Ryan U, Hijjawi N, Feng Y, Xiao L. Giardia: An under-reported foodborne parasite. Int J Parasitol 2019; 49:1-11. doi:10.1016/j.ijpara.2018.07.003
Dougherty M, Bartelt LA. Girdia and growth impairment in children in high-prevalence settings: consequence or co-incidence? Curr Opin Infect Dis 2022; 35:417-23. doi:10.1097/QCO.0000000000000877
Hemphil A, Muller N, Muler J. Comparative pathobiology of the intestinal protozoan parasites Giardia lamblia, entamoeba histolytica, and Cryptosporidium parvum. J Pathog 2019; 8:116. doi:10.3390/pathogens8030116
Rogawski ET, Bartelt LA, Platts-Mills JA, Seidman JC, Samie A, Havt A, et al. Determinants and impact of giardia infection in the first 2 years of life in the mal-ed birth cohort. J Pediatric Infect Dis Soc 2017; 6:153-60. doi:10.1093/jpids/piw082
Pouryousef A, Fararouei M, Sarkari B. Antigen-based diagnosis of human giardiasis: A systematic review and meta-analysis. Iran J Parasitol 2023; 18:140-54. doi:10.18502/ijpa.v18i2.13180
Hooshyar H, Rostamkhani P, Arbabi M, Delavari M. Giar-dia lamblia infection: Review of current diagnostic strategies. Gastroenterol Hepatol Bed Bench 2019; 12:3-12. doi:10.22037/ghfbb.v0i0.1414
Khattak I, Yen WL, Usman T, Nasreen N, Khan A, Ahmad S, et al. Individual and community-level risk factors for giardiasis in children under five years of age in Pakistan: A prospective multi-regional study. Children (Basel) 2023; 10:1087. doi:10.3390/children10061087
Nawaz Z, Rasool MH, Siddique AB, Zahoor MA, Naz A, Ali S, et al. Frequency and molecular detection of giardia intestinalis in children attending pediatrics of Punjab, Pakistan. Jundishapur J Microbiol 2020; 13:e97080 doi:10.5812/jjm.97080
Veronesi F, Passamonti F, Caccio S, Diaferia M, Piergili Fioretti D. Epidemiological survey on equine cryptosporidium and giardia infections in Italy and molecular characterization of isolates. Zoonoses Public Health 2010; 57:510-7. doi:10.1111/j.1863-2378.2009.01261
Zaki DM. Prevalence of entamoeba histolytica and giar-dia lamblia associated with diarrhea in children referring to lbn al-atheer hospital in mosul, Iraq. Arch Razi Inst 2022; 77:73-9. doi:10.22092/ARI.2021.356312.182012
Khan AH, Gul NA, Hammad HM, Bibi Y, Bibi A, Mohsan J. Prevalence of giardia intestinalis and hymenolepis nana in Afghan refugee population of Mianwali district, Pakistan. Afr Health Sci 2015; 15:394-400. doi:10.4314/ahs.v15i2.12
Senaviratna N, Cooray T. Multicollinearity in binary logi-stic regression model. Theory Pract Math Comput Sci 2021; 8:11-9. doi:10.9734/bpi/tpmcs/v6/2417E
Ali IY, Mero WM, Mohammed AB. Prevalence and risk factors of giardia lamblia among infants and children in duhok province/kurdistan region, Iraq. Asian J Nurs 2022; 11:147-52. doi:10.25007/ajnu.v11n4a1597
Naz A, Nawaz Z, Rasool MH, Zahoor MA. Cross-sectional epidemiological investigations of giardia lamblia in children in Pakistan. Sao Paulo Med J 2018; 136:449-53. doi:10.1590/1516-3180.2018.0350060918
Anim-Baidoo I, Narh CA, Oddei D, Brown CA, Enweronu-Laryea C, Bandoh B, et al. Giardia lamblia infections in children in Ghana. Pan Afr Med J 2016; 24:217. doi:10.11604/pamj.2016.24.217.8012
Ali SH, Foster T, Hall NL. The relationship between infectious diseases and housing maintenance in Indigenous Australian households. Int J Environ Res Public Health 2018; 15:2827 doi:10.3390/ijerph15122827
Fahim SM, Das S, Gazi MA, Mahfuz M, Ahmed T. Association of intestinal pathogens with fecal markers of environmental enteric dysfunction among slum-dwelling children in Bangladesh's first 2 years of life. Trop Med Int Health 2018; 23:1242-50.doi:10.1111/tmi.13141
Foster T, Rand E, Sami E, Dance B, Kohlitz J, Willetts J. Does the source of water for piped supplies affect child health? Evidence from rural Vanuatu. J Water Sanit Hyg Dev 2019; 9:591-5. doi:10.2166/washdev.2019.161
Hassan GZ, Shabir G, Akhtar S, Rafique H, Hassan MA. Groundwater and nutritional health challenges- a case study from indus river system in pakistan. J Nutr Health Food Eng 2022; 12:61-4. doi:10.15406/jnhfe.2022.12.00357
Ishaque W, Tanvir R, Mukhtar M. Climate change and water crises in Pakistan: Implications on water quality and health risks. J Environ Public Health 2022; 2022:1-12. doi:10.1155/2022/5484561
Bahari A, Nazemi H, Ganji A, Farzanehfar M, Namdar AB, Goshayeshi L, et al. Association between giardia duodenalis infection and irritable bowel syndrome. Acta Med Iran 2023; 61:289-93. doi:10.18502/acta.v61i5.13484
Roshidi N, Arifin N. Disease biomarkers of giardiasis. J Parasitol Res 2022; 2022:1-12. doi:10.1155/2022/1932518
Mochungong PI, Gulis G, Sodeman M. Morbidity among children living around clinical waste treatment and disposal site in the northwest region of cameroon. J Public Health Afr 2011; 2:e13. doi:10.4081/jphia.2011.e13
Quazi S, Wadde SK, Nagaonkar AS. Hand washing practices amongst mothers of under-fives in an urban slum. Int J Community Med Public Health 2019; 6:4748. doi:10.18203/2394-6040.ijcmph20195050
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Mahnoor Ali, Syed Nayer Mahmud
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. 
