SUN Qice,YU Dongrong,CHEN Hongyu, et al. Clinicopathological features and prognosis of IgA nephropathy with different proportions of crescentic lesions[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2017, 47(3): 201-205.
Abstract：Objective: To explore the clinicopathologic features and prognosis of IgA nephropathy (IgAN) with different proportions of crescentic lesions. Methods: In total, 1 054 patients who underwent renal biopsy in our hospital from January 2001 to December 2007 were enrolled. We grouped the patients as follows, based on the proportion of crescentic lesions at diagnosis: mild group (≤10%, n=271), moderate group (>10% to ≤25%, n=182), and severe group (>25%, n=46), and control group (no crescent formations, n=555). Renal survival curves were generated with the Kaplan Meier method. Univariate and multivariate Cox regression model was used to analysis the prognostic value of crescent in IgAN. Results: Of the 1 054 subjects, mean proportion of crescent was 13.2%±15.7%. The proportion of crescents was significantly correlated with the urine protein concentration, serum creatinine concentration, estimated glomerular filtration rate, cholesterol, triglyceride, albumin, and hemoglobin concentration (P<0.05). Pathological indices, such as mesangial proliferation, glomerular sclerosis, and chronic pathological changes (e.g., tubular atrophy/interstitial fibrosis) showed significant differences among the four groups; an increased crescent proportion was especially pathologic (P<0.05). Renal failure was observed in 114 (10.8%) patients at a median of 90.0 months (interquartile range: 62.1-113.7 months). Kaplan Meier analysis revealed that the cumulative renal survival also significantly differed among the four groups (χ2=13.35, P<0.01). In the univariate and multivariable Cox hazards regression, only a higher proportion of crescentic lesions (>25%) had a higher predictive value (P<0.05). Conclusion: The correlation between crescentic lesions and clinicopathologic features in patients with IgAN reflects the degree of disease progression. A higher proportion of crescentic lesions (>25%) in these patients is an independent risk factor for progression to renal failure.
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