Crescents proportion no lower than 14％ were significantly associated with renal function and outcomes of IgA nephropathy patients / 中华肾脏病杂志

ABSTRACT

Objective To explore the clinicopathological features and outcomes of IgA nephropathy patients with different proportions of crescents.Methods A total of 270 patients who were diagnosed as IgA nephropathy by renal biopsies from January 2010 to December 2015 in the First Affiliated Hospital of Shenzhen University were enrolled.All patients were divided into 3 groups according to the optimal cutoff level of crescents proportion in the Receiver Operating Characteristic Curve (ROC) as follows0％,＜ 14％;≥ 14％.The endpoint was defined as the doubling of baseline serum creatinine (Scr) and/or end-stage renal disease (ESRD).Kaplan-Meier curve and Cox regression model were used to analyze the renal survival among three groups.Results One hundred and four patients (38.5％) without any crescents;84 patients (31.1％) with crescents proportion ＜ 14％ and 82 patients (31.4％) with crescents proportion ≥14％.Patients with crescents proportion ≥14％ group were older and had higher level of systolic blood pressure and diastolic blood pressure,24-hour urine protein and serum uric acid level;more patients treated with RAS blocker,glucocorticoid and immunotherapy,but lower eGFR,hemoglobin and serum albumin level than those with crescents proportion ＜ 14％.Compared with those without crescents and crescent proportion ＜ 14％,patients with crescent proportion ≥ 14％ also had higher proportion of global glomerulosclerosis,more endocapillary hypercellularity and severe tubulointerstitial lesions,higher degree of IgA and C3 depositions in renal.24-hour proteinuria,serum uric acid level,low hemoglobin level,endocapillary hypercellularity and renal C3 depositions were risk factors for crescents formation.Patients were followed-up for a median of (31.7±21.0) months,and Kaplan-Meier analysis revealed that renal survival rate was significantly lower in patients with crescents proportion ≥ 14％ compared with other groups (P=0.001).But there was no significant difference between no crescent group and crescents proportion ＜ 14％ group.However,multivariate Cox analysis showed no significant difference between crescents proportion and renal survival.Conclusion Crescents proportion is associated with higher risk of renal function and renal progression.