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, TaeHyun Yoo, Shin-Wook Kang, Kyu Hun Choi, Beom Jin Lim, Hyeon Joo Jeong, SeungHyeok 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, TaeHyun ; Kang, Shin-Wook ; Choi, Kyu Hun ; Lim, Beom Jin ; Jeong, Hyeon Joo ; Han, SeungHyeok. / 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 TaeHyun Yoo and Shin-Wook Kang and Choi, {Kyu Hun} and Lim, {Beom Jin} and Jeong, {Hyeon Joo} and SeungHyeok Han",
year = "2014",
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doi = "10.1093/ndt/gft398",
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Lee, MJ, Kim, SJ, Oh, HJ, Ko, KI, Koo, HM, Kim, CH, Doh, FM, Yoo, T, Kang, S-W, Choi, KH, Lim, BJ, Jeong, HJ & Han, S 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, TaeHyun; Kang, Shin-Wook; Choi, Kyu Hun; Lim, Beom Jin; Jeong, Hyeon Joo; Han, SeungHyeok.

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, TaeHyun

AU - Kang, Shin-Wook

AU - Choi, Kyu Hun

AU - Lim, Beom Jin

AU - Jeong, Hyeon Joo

AU - Han, SeungHyeok

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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U2 - 10.1093/ndt/gft398

DO - 10.1093/ndt/gft398

M3 - Article

VL - 29

SP - 356

EP - 364

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

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