title: Prediction of outcomes in crescentic IgA nephropathy in a multicenter cohort study.
abstract: Crescentic IgA nephropathy (IgAN), defined as >50% crescentic glomeruli on kidney biopsy, is one of the most common causes of rapidly progressive GN. However, few studies have characterized this condition. To identify risk factors and develop a prediction model, we assessed data from patients ≥ 14 years old with crescentic IgAN who were followed ≥ 12 months. The discovery cohort comprised 52 patients from one kidney center, and the validation cohort comprised 61 patients from multiple centers. At biopsy, the mean serum creatinine (SCr) level ± SD was 4.3 ± 3.4 mg/dl, and the mean percentage of crescents was 66.4%± 15.8%. The kidney survival rates at years 1, 3, and 5 after biopsy were 57.4%± 4.7%, 45.8%± 5.1%, and 30.4%± 6.6%, respectively. Multivariate Cox regression revealed initial SCr as the only independent risk factor for ESRD (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.10 to 1.57; P=0.002). Notably, the percentage of crescents did not associate independently with ESRD. Logistic regression showed that the risk of ESRD at 1 year after biopsy increased rapidly at SCr>2.7 mg/dl and reached 90% at SCr>6.8 mg/dl (specificity=98.5%, sensitivity=64.6% for combined cohorts). In both cohorts, patients with SCr>6.8 mg/dl were less likely to recover from dialysis. Analyses in additional cohorts revealed a similar association between initial SCr and ESRD in patients with antiglomerular basement membrane disease but not ANCA-associated systemic vasculitis. In conclusion, crescentic IgAN has a poor prognosis, and initial SCr concentration may predict kidney failure in patients with this disease.
authors.affiliation: Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China;
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.forename: Yihe
authors.initials: Y
authors.lastname: Yang
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Wenfang
authors.initials: W
authors.lastname: Chen
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Pan
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Guo
authors.forename: Caili
authors.initials: C
authors.lastname: Wang
authors.forename: Shen
authors.initials: S
authors.lastname: Li
authors.forename: Jianrong
authors.initials: J
authors.lastname: Zhang
authors.forename: Jianchun
authors.initials: J
authors.lastname: Zhang
authors.forename: Lijun
authors.initials: L
authors.lastname: Liu
authors.forename: Sufang
authors.initials: S
authors.lastname: Shi
authors.forename: Suxia
authors.initials: S
authors.lastname: Wang
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Zhao
authors.initials: Z
authors.lastname: Cui
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.forename: Minghui
authors.initials: M
authors.lastname: Zhao
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005922:Glomerulonephritis, IGA / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D014657:Vasculitis / Q000401:mortality / Q000473:pathology; D055815:Young Adult
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