Abstract: TH-OR024

Presence of Cellular or Fibrocellular Crescent Is Important for a Long-Term Renal Prognosis in Patients with IgA Nephropathy Followed for 10 Years or Longer on Average

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Fujii, Takayuki, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Suzuki, Satoshi, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Terasaki, Noriko, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Saito, Kaiji, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Shinozaki, Mizuki, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Morimoto, Mayu, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
  • Hiroaki, Tanaka, Seirei Sakura Citizen Hospital, Sakura-shi Chiba, Japan
Background

Regarding the prognosis of patients with IgA nephropathy, the addition of the crescent score: C0 (no crescent), C1 (crescents in more than zero but less than one fourth of glomeurli), and C2 (crescents in one fourth or more of glomeruli), to the conventional factors of the Oxford classification: M, E, S, T score has been proposed (J Am Soc Nephrol 2017). However, the observation period in the above study was relatively short (mean: 4.7 years) and it is unclear whether the C score, which may be modified by treatment, serves as a factor associated with the long-term prognosis of patients followed for more than 10 years on average. We investigated the influence of the C score on the long-term prognosis.

Methods

The subjects were 658 patients with biopsy-proven IgA nephropathy who could be followed up for one year or longer, or reached end stage kidney disease and required renal replacement therapy within one year. A single-center retrospective cohort study was performed involving these patients. Setting the outcome at 50% reduction of eGFR, the influence of the C score on the prognosis was investigated using the Kaplan-Meier method and Cox proportional hazard model. Model A was adjusted with the clinicopathological data including time average proteinuria (TAP) and time average mean blood pressure (TAMAP) during the course, and the M, E, S, and T scores, and model B was adjusted with model A + treatment with or without steroid and RAS inhibitors for analysis.

Results

The mean observation period was 10.9±8.8 years, eGFR at the time of kidney biopsy was 75.8±26.4 mL/min/1.73 m2, TAP was 0.8±1.2 g/day, C1 and C2 accounted for 18.2% and 1.5%, respectively, and the outcome was reached in 18.0%. On analysis using the Kaplan-Meier method, the outcome was significantly more favorable in the order of C0, C1, and C2 (log-rank p<0.0001). Regarding C0 as the reference, HR of C1 or higher was 1.68 (95% CI: 1.04-2.64) in model A and 1.81 (95% CI: 1.11-2.87) in model B, showing that the score was applicable as a prognostic predictor in addition to the Oxford T score, TAP and TAMAP, and eGFR at the time of kidney biopsy.

Conclusion

The C score was important for a long-term renal prognosis even when treatment was included in the analysis.