Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study

Sehoon Park, Chung Hee Baek, Su Kil Park, Hee Gyung Kang, Hye Sun Hyun, Eujin Park, Seung Hyeok Han, Dong Ryeol Ryu, Dong Ki Kim, Kook Hwan Oh, Kwon Wook Joo, Yon Su Kim, Kyung Chul Moon, Ho Jun Chin, Hajeong Lee

Research output: Contribution to journalArticle

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Abstract

Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P< 0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents.

Original languageEnglish
Pages (from-to)22-32
Number of pages11
JournalKidney and Blood Pressure Research
Volume44
Issue number1
DOIs
Publication statusPublished - 2019 Mar 1

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Validation Studies
IGA Glomerulonephritis
Immunoglobulin A
Multicenter Studies
Glomerular Filtration Rate
Chronic Kidney Failure
Kidney
Korea
Proportional Hazards Models
Cohort Studies
Retrospective Studies
Regression Analysis
Biopsy
Population

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Cardiology and Cardiovascular Medicine

Cite this

Park, S., Baek, C. H., Park, S. K., Kang, H. G., Hyun, H. S., Park, E., ... Lee, H. (2019). Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study. Kidney and Blood Pressure Research, 44(1), 22-32. https://doi.org/10.1159/000497808
Park, Sehoon ; Baek, Chung Hee ; Park, Su Kil ; Kang, Hee Gyung ; Hyun, Hye Sun ; Park, Eujin ; Han, Seung Hyeok ; Ryu, Dong Ryeol ; Kim, Dong Ki ; Oh, Kook Hwan ; Joo, Kwon Wook ; Kim, Yon Su ; Moon, Kyung Chul ; Chin, Ho Jun ; Lee, Hajeong. / Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study. In: Kidney and Blood Pressure Research. 2019 ; Vol. 44, No. 1. pp. 22-32.
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abstract = "Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6{\%}) patients with C1 and 60 (1.8{\%}) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P< 0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents.",
author = "Sehoon Park and Baek, {Chung Hee} and Park, {Su Kil} and Kang, {Hee Gyung} and Hyun, {Hye Sun} and Eujin Park and Han, {Seung Hyeok} and Ryu, {Dong Ryeol} and Kim, {Dong Ki} and Oh, {Kook Hwan} and Joo, {Kwon Wook} and Kim, {Yon Su} and Moon, {Kyung Chul} and Chin, {Ho Jun} and Hajeong Lee",
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Park, S, Baek, CH, Park, SK, Kang, HG, Hyun, HS, Park, E, Han, SH, Ryu, DR, Kim, DK, Oh, KH, Joo, KW, Kim, YS, Moon, KC, Chin, HJ & Lee, H 2019, 'Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study', Kidney and Blood Pressure Research, vol. 44, no. 1, pp. 22-32. https://doi.org/10.1159/000497808

Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study. / Park, Sehoon; Baek, Chung Hee; Park, Su Kil; Kang, Hee Gyung; Hyun, Hye Sun; Park, Eujin; Han, Seung Hyeok; Ryu, Dong Ryeol; Kim, Dong Ki; Oh, Kook Hwan; Joo, Kwon Wook; Kim, Yon Su; Moon, Kyung Chul; Chin, Ho Jun; Lee, Hajeong.

In: Kidney and Blood Pressure Research, Vol. 44, No. 1, 01.03.2019, p. 22-32.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical significance of crescent formation in IgA nephropathy-A multicenter validation study

AU - Park, Sehoon

AU - Baek, Chung Hee

AU - Park, Su Kil

AU - Kang, Hee Gyung

AU - Hyun, Hye Sun

AU - Park, Eujin

AU - Han, Seung Hyeok

AU - Ryu, Dong Ryeol

AU - Kim, Dong Ki

AU - Oh, Kook Hwan

AU - Joo, Kwon Wook

AU - Kim, Yon Su

AU - Moon, Kyung Chul

AU - Chin, Ho Jun

AU - Lee, Hajeong

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P< 0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents.

AB - Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P< 0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents.

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