TY - JOUR
T1 - Clinical implication of the circumferential crescents lesions in immunoglobulin A nephropathy
T2 - a single-center study of Han Chinese population
AU - Yang, Danyi
AU - Liu, Haiyang
AU - Peng, Youmin
AU - Fu, Ying
AU - Chen, Anqun
AU - Xu, Xiangqing
AU - Yuan, Shuguang
AU - Dong, Zheng
AU - Liu, Yu
AU - Liu, Hong
N1 - Funding Information:
Funding/Support: This work was supported by the National Natural Science Foundation of China (No. 81770714 , 81800650 and 82070737 ), Nature Science Foundation of Hunan Province , China (No. 2018JJ2585 ), the Hunan Provincial Innovation Foundation for Postgraduate (No. CX20200123) and the Fundamental Research Funds for Central Universities of the Central South University (No. 2020zzts279 ).
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/12
Y1 - 2021/12
N2 - A crescentic lesion in renal biopsy could be segmental or circumferential, but the distribution and clinical implication of the circumferential crescents in immunoglobulin A nephropathy (IgAN) remains unknown. A total of 384 crescentic IgAN patients between 2011 and 2019 were included. The subjects were classified as the circumferential crescent who have at least one crescent involving ≥50% circumference of Bowman's capsule, otherwise as to the segmental crescent. Clinical, pathological, and prognostic relationships were analyzed. The primary endpoint was a 30% decline in eGFR, and the secondary endpoint was more than 3.5 g/d proteinuria during follow-up. Of the 384 patients, 72 (18.8%) patients had more than one circumferential crescent. 52 (17.6%) Oxford C1 patients have circumferential crescent. During a mean follow-up of 32.3 months, both the primary and secondary endpoints have occurred more in the circumferential crescent patients. Kaplan–Meier analysis showed the patient with the circumferential crescent had significantly lower renal survival than those without. In multivariable Cox analyses, having the circumferential crescents in at least one-fifth of glomeruli was independently associated with primary endpoint (hazard ratio:3.60, 95% CI:1.46–8.83), after adjusting for Oxford-score, eGFR, systolic blood pressure, and proteinuria. Furthermore, those patients who scored C1 in Oxford and presenting with circumferential crescents, had better renal survival if they received the other immunosuppressants therapy. The circumferential crescents lesion was associated with adverse outcomes in IgAN, and more than one-fifth of glomeruli circumferential crescents is an independent predictor of 30% eGFR decline after adjusting for clinical and histological parameters.
AB - A crescentic lesion in renal biopsy could be segmental or circumferential, but the distribution and clinical implication of the circumferential crescents in immunoglobulin A nephropathy (IgAN) remains unknown. A total of 384 crescentic IgAN patients between 2011 and 2019 were included. The subjects were classified as the circumferential crescent who have at least one crescent involving ≥50% circumference of Bowman's capsule, otherwise as to the segmental crescent. Clinical, pathological, and prognostic relationships were analyzed. The primary endpoint was a 30% decline in eGFR, and the secondary endpoint was more than 3.5 g/d proteinuria during follow-up. Of the 384 patients, 72 (18.8%) patients had more than one circumferential crescent. 52 (17.6%) Oxford C1 patients have circumferential crescent. During a mean follow-up of 32.3 months, both the primary and secondary endpoints have occurred more in the circumferential crescent patients. Kaplan–Meier analysis showed the patient with the circumferential crescent had significantly lower renal survival than those without. In multivariable Cox analyses, having the circumferential crescents in at least one-fifth of glomeruli was independently associated with primary endpoint (hazard ratio:3.60, 95% CI:1.46–8.83), after adjusting for Oxford-score, eGFR, systolic blood pressure, and proteinuria. Furthermore, those patients who scored C1 in Oxford and presenting with circumferential crescents, had better renal survival if they received the other immunosuppressants therapy. The circumferential crescents lesion was associated with adverse outcomes in IgAN, and more than one-fifth of glomeruli circumferential crescents is an independent predictor of 30% eGFR decline after adjusting for clinical and histological parameters.
KW - Circumferential
KW - Crescents
KW - IgA nephropathy
KW - Immunosuppressants
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85122487648&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122487648&partnerID=8YFLogxK
U2 - 10.1016/j.humpath.2021.09.003
DO - 10.1016/j.humpath.2021.09.003
M3 - Article
C2 - 34592241
AN - SCOPUS:85122487648
SN - 0046-8177
VL - 118
SP - 49
EP - 59
JO - Human Pathology
JF - Human Pathology
ER -