Clinical implication of crescentic lesions in immunoglobulin A nephropathy

Mi Jung Lee, Seung Jun Kim, Hyung Jung Oh, Kwang Il Ko, Hyang Mo Koo, Chan Ho Kim, Fa Mee Doh, Tae Hyun Yoo, Shin Wook Kang, Kyu Hun Choi, Beom Jin Lim, Hyeon Joo Jeong, Seung Hyeok Han

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Abstract

Background. To date, there has been much controversy about the role of crescentic lesion as a significant prognostic factor in immunoglobulin A nephropathy (IgAN). This study evaluated whether crescentic lesions predict adverse renal outcomes in IgAN patients. Methods. A total of 430 patients with biopsy-proven IgAN between January 2000 and December 2009 were included. Histological variables of the Oxford classification (Oxford-MEST) and the presence of crescents were assessed. The primary endpoint was a 50% decline in estimated glomerular filtration rate. Results. Of the 430 patients, 81 (18.8%) had a crescentic lesion. During a mean follow-up of 61 months, the primary outcome occurred in 19 (23.5%) patients with crescents compared with 40 (11.5%) patients without crescents (P = 0.01). A Kaplan-Meier plot showed that the 10-year renal survival rate was significantly lower in patients with crescents than patients without crescents (P = 0.01). However, in a multivariable Cox analysis which included clinical factors and the Oxford-MEST, crescents were not significantly associated with an increased risk of developing the primary outcome [hazard ratio: 0.71, 95% confidence interval (CI) 0.36-1.41, P = 0.33]. Furthermore, adding crescents to the Oxford-MEST did not improve the discriminative ability for the prediction of renal outcomes [c-statistic: 0.86 (0.81-0.91) vs. 0.86 (0.80-0.91), P = 0.21].ConclusionCrescentic lesion was not an independent prognostic factor, suggesting that crescents have limited value in predicting renal outcomes of IgAN.

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalNephrology Dialysis Transplantation
Volume29
Issue number2
DOIs
Publication statusPublished - 2014 Feb 1

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

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    Lee, M. J., Kim, S. J., Oh, H. J., Ko, K. I., Koo, H. M., Kim, C. H., Doh, F. M., Yoo, T. H., Kang, S. W., Choi, K. H., Lim, B. J., Jeong, H. J., & Han, S. H. (2014). Clinical implication of crescentic lesions in immunoglobulin A nephropathy. Nephrology Dialysis Transplantation, 29(2), 356-364. https://doi.org/10.1093/ndt/gft398