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

Research output: Contribution to journalArticle

23 Citations (Scopus)

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

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IGA Glomerulonephritis
Kidney
Glomerular Filtration Rate
Survival Rate
Confidence Intervals
Biopsy

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Lee, Mi Jung ; Kim, Seung Jun ; Oh, Hyung Jung ; Ko, Kwang Il ; Koo, Hyang Mo ; Kim, Chan Ho ; Doh, Fa Mee ; Yoo, Tae Hyun ; Kang, Shin Wook ; Choi, Kyu Hun ; Lim, Beom Jin ; Jeong, Hyeon Joo ; Han, Seung Hyeok. / Clinical implication of crescentic lesions in immunoglobulin A nephropathy. In: Nephrology Dialysis Transplantation. 2014 ; Vol. 29, No. 2. pp. 356-364.
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title = "Clinical implication of crescentic lesions in immunoglobulin A nephropathy",
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.",
author = "Lee, {Mi Jung} and Kim, {Seung Jun} and Oh, {Hyung Jung} and Ko, {Kwang Il} and Koo, {Hyang Mo} and Kim, {Chan Ho} and Doh, {Fa Mee} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Lim, {Beom Jin} and Jeong, {Hyeon Joo} and Han, {Seung Hyeok}",
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Lee, MJ, Kim, SJ, Oh, HJ, Ko, KI, Koo, HM, Kim, CH, Doh, FM, Yoo, TH, Kang, SW, Choi, KH, Lim, BJ, Jeong, HJ & Han, SH 2014, 'Clinical implication of crescentic lesions in immunoglobulin A nephropathy', Nephrology Dialysis Transplantation, vol. 29, no. 2, pp. 356-364. https://doi.org/10.1093/ndt/gft398

Clinical implication of crescentic lesions in immunoglobulin A nephropathy. / Lee, Mi Jung; Kim, Seung Jun; Oh, Hyung Jung; Ko, Kwang Il; Koo, Hyang Mo; Kim, Chan Ho; Doh, Fa Mee; Yoo, Tae Hyun; Kang, Shin Wook; Choi, Kyu Hun; Lim, Beom Jin; Jeong, Hyeon Joo; Han, Seung Hyeok.

In: Nephrology Dialysis Transplantation, Vol. 29, No. 2, 01.02.2014, p. 356-364.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical implication of crescentic lesions in immunoglobulin A nephropathy

AU - Lee, Mi Jung

AU - Kim, Seung Jun

AU - Oh, Hyung Jung

AU - Ko, Kwang Il

AU - Koo, Hyang Mo

AU - Kim, Chan Ho

AU - Doh, Fa Mee

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Lim, Beom Jin

AU - Jeong, Hyeon Joo

AU - Han, Seung Hyeok

PY - 2014/2/1

Y1 - 2014/2/1

N2 - 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.

AB - 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.

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DO - 10.1093/ndt/gft398

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