A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy.
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 m2and 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 one fourth or more of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California; mark.haas@cshs.org.
Mark
M
Haas
Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
Jacobien C
JC
Verhave
Department of Nephrology, National Clinical Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Zhi-Hong
ZH
Liu
Department of Pathology, University of Washington School of Medicine, Seattle, Washington.
Charles E
CE
Alpers
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.
Jonathan
J
Barratt
Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
Jan U
JU
Becker
Department of Medicine and Toronto General Research Institute, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
Daniel
D
Cattran
Centre for Complement and Inflammation Research, Department of Medicine, Imperial College, London, United Kingdom.
H Terence
HT
Cook
Fondazione Ricerca Molinette, Nephrology, Dialysis, and Transplantation, Regina Margherita Hospital, Turin, Italy.
Rosanna
R
Coppo
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.
John
J
Feehally
Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy.
Antonello
A
Pani
Department of Nephrology, Transplantation Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Agnieszka
A
Perkowska-Ptasinska
Department of Cellular Pathology, Oxford University Hospitals, Oxford, United Kingdom.
Ian S D
IS
Roberts
Department of Pathology, Federal University of Sao Paolo, Sao Paolo, Brazil.
Maria Fernanda
MF
Soares
Department of Nephrology, Nephrology Service and Kidney Transplant Unit, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Hernan
H
Trimarchi
Department of Pathology, Laboratory of Electron Microscopy, Pathological Centre and.
Suxia
S
Wang
Department of Nephrology, Fujita Health University School of Medicine, Toyoake Aichi, Japan.
Yukio
Y
Yuzawa
Renal Division, Peking University First Hospital, Beijing, China.
Hong
H
Zhang
Division of Nephrology, Department of Medicine, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and.
Stéphan
S
Troyanov
Kidney Unit, National Fukuoka Higashi Medical Center, Fukuoka, Japan.
Ritsuko
R
Katafuchi
D000328:Adult; D001706:Biopsy; D005260:Female; D005922:Glomerulonephritis, IGA / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies
IgA nephropathy; Oxford classification; Renal pathology; crescents; glomerulonephritis