62
IRUS Total
Downloads
  Altmetric

A multicenter study of the predictive value of crescents in IgA nephropathy

File Description SizeFormat 
JASN-2016-04-0433 revised MH 6-20-16 RK 6-20-16.docxAccepted version540.48 kBMicrosoft WordView/Open
Title: A multicenter study of the predictive value of crescents in IgA nephropathy
Authors: Haas, M
Verhave, JC
Liu, ZH
Alpers, CE
Barratt, J
Becker, JU
Cattran, D
Cook, HT
Coppo, R
Feehally, J
Pani, A
Perkowska-Ptasinska, A
Roberts, IS
Soares, MF
Trimarchi, H
Wang, S
Yuzawa, Y
Zhang, H
Troyanov, S
Katafuchi, R
Item Type: Journal Article
Abstract: The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a ≥50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean±SD eGFR of 78±29 ml/min per 1.73 m(2) and median (interquartile range) proteinuria of 1.2 (0.7-2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression. We propose adding the following crescent scores to the Oxford Classification: C0 (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in over one fourth of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.
Issue Date: 1-Feb-2017
Date of Acceptance: 14-Jul-2016
URI: http://hdl.handle.net/10044/1/41711
DOI: 10.1681/ASN.2016040433
ISSN: 1533-3450
Publisher: American Society of Nephrology
Start Page: 691
End Page: 701
Journal / Book Title: Journal of the American Society of Nephrology
Volume: 28
Issue: 2
Copyright Statement: Copyright © 2016 by the American Society of Nephrology. A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy Mark Haas, Jacobien C. Verhave, Zhi-Hong Liu, Charles E. Alpers, Jonathan Barratt, Jan U. Becker, Daniel Cattran, H. Terence Cook, Rosanna Coppo, John Feehally, Antonello Pani, Agnieszka Perkowska-Ptasinska, Ian S.D. Roberts, Maria Fernanda Soares, Hernan Trimarchi, Suxia Wang, Yukio Yuzawa, Hong Zhang, Stéphan Troyanov, and Ritsuko Katafuchi JASN ASN.2016040433; published ahead of print September 9, 2016, https://dx.doi.org/10.1681/ASN.2016040433
Keywords: IgA nephropathy
Oxford classification
Renal pathology
crescents
glomerulonephritis
Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
GLOMERULAR-FILTRATION-RATE
OXFORD CLASSIFICATION
CLINICOPATHOLOGICAL CORRELATIONS
REPEAT-BIOPSY
VALIDATION
LESIONS
IgA nephropathy
Oxford classification
Renal pathology
crescents
glomerulonephritis
Adult
Biopsy
Female
Glomerulonephritis, IGA
Humans
Male
Predictive Value of Tests
Retrospective Studies
Humans
Glomerulonephritis, IGA
Biopsy
Retrospective Studies
Predictive Value of Tests
Adult
Female
Male
1103 Clinical Sciences
Urology & Nephrology
Publication Status: Published
Online Publication Date: 2016-09-09
Appears in Collections:Department of Immunology and Inflammation
Faculty of Medicine