A multicenter study of the predictive value of crescents in IgA nephropathy

Mark Haas, Jacobien C. Verhave, Zhi Hong Liu, Charles E. Alpers, Jonathan Barratt, Jan U. Becker, Daniel Cattran, H. Terence Cook, Rosanna Coppo, John Feehally, Antonello Pani, Agnieszka Perkowska-Ptasinska, Ian S.D. Roberts, Maria Fernanda Soares, Hernan Trimarchi, Suxia Wang, Yukio Yuzawa, Hong Zhang, Stéphan Troyanov, Ritsuko Katafuchi

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The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a ≥50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean±SD eGFR of 78±29 ml/min per 1.73 m2 and median (interquartile range) proteinuria of 1.2 (0.7-2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression.We propose adding the following crescent scores to the Oxford Classification: C0 (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in over one fourth of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.

元の言語English
ページ(範囲)691-701
ページ数11
ジャーナルJournal of the American Society of Nephrology
28
発行部数2
DOI
出版物ステータスPublished - 02-2017

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All Science Journal Classification (ASJC) codes

  • Nephrology

これを引用

Haas, M., Verhave, J. C., Liu, Z. H., Alpers, C. E., Barratt, J., Becker, J. U., Cattran, D., Cook, H. T., Coppo, R., Feehally, J., Pani, A., Perkowska-Ptasinska, A., Roberts, I. S. D., Soares, M. F., Trimarchi, H., Wang, S., Yuzawa, Y., Zhang, H., Troyanov, S., & Katafuchi, R. (2017). A multicenter study of the predictive value of crescents in IgA nephropathy. Journal of the American Society of Nephrology, 28(2), 691-701. https://doi.org/10.1681/ASN.2016040433