The predictive value of crescents in adult Henoch-Sch(o)lein purpura nephritis / 中华肾脏病杂志

ABSTRACT

Objective To study the renal prognosis with the type and proportion of crescentic in adult Henoch Schonlein purpura nephritis (HSPN).Methods A total of 275 HSPN cases diagnosed in the First Affiliated Hospital of Zhejiang University were retrospectively analyzed.According to the pathological results,they were divided into four groups99 patients in none crescent group (NC),35 patients in segmental crescents group (SC),122 patients with circumferential crescent ＜25％ (C1),and 19 patients with circumferential crescent≥25％ (C2).Renal prognostic events were defined as estimated glomerular filtration rate (eGFR) decreased by 30％ over baseline within 2 years,doubling of serum creatinine or end-stage renal disease during follow-up.Kaplan-Meier survival analysis was used to compare the renal survival rate of each group.Univariate and multivariate Cox regression model was used to recognize the risk factor of poor renal outcome.Results There was no significant difference in age,extra renal organ performance and mean arterial pressure among groups.Among NC group,SC group,C1 group and C2 group,difference in serum creatinine (P=0.001),eGFR (P=0.003) and proteinuria levels (P ＜ 0.001) were statistically significant.There was no significant difference in the ratio of global sclerosis,mesangial hypercellularity and interstitial inflammation/fibrosis among the groups.The patients were followed up for 86(58,116) months.The renal survival rates of NC group,SC group,C1 group and C2 group were 96％,100％,83.6％ and 68.4％ respectively.Kaplan-meier survival analysis showed significant differences (Log Rank=23.24,P＜ 0.001).Cox multivariate regression analysis indicated that presence of circumferential crescent (HR=3.59,95％CI 1.34-9.62,P=0.008) and low eGFR (HR=0.979,95％ CI 0.968-0.989,P ＜ 0.001) were independent prognostic factors.Conclusion The presence of circumferential crescent and low eGFR level are independent risk factors for poor renal prognosis in HSPN patients.