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Abstract: TH-PO1031

Crescentic Lesions in IgA Nephropathy: Impact on Outcome

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Correia, Sofia, Centro Hospitalar do Porto, Porto, Portugal
  • Silva, Filipa Santos, Centro Hospitalar e Universitário do Porto, Porto, Portugal
  • Santos, Sofia, Centro Hospitalar do Porto, Porto, Portugal
  • Castro, Ana, Centro Hospitalar do Porto, Porto, Portugal
  • Tavares, Joana Manuel, Centro Hospitalar do Porto, Porto, Portugal
  • Campos, Andreia, Centro Hospitalar do Porto, Porto, Portugal
  • Moreira, Carla L., Centro Hospitalar do Porto, Porto, Portugal
  • Malheiro, Jorge, Nephrology Department - Centro Hospitalar Porto, Porto, Portugal
  • Lascasas, Josefina, CHP- Hospital Santo Antonio, Porto, Portugal
Background

Recently,IgAN Classification Working Group has published an update to the Oxford Classification that recommends changing the MEST to a MEST-C score,defending that the fraction of crescents are associated with outcome.Nevertheless,the role of crescentic lesions is still controversial and needs better characterization.The aim was to study the impact of the crescents in the outcome in our population.

Methods

A total of 88patients with biopsy-proven IgAN between January'07 and December'17 were re-assessed using the MEST-C,in this retrospective analysis.The composite outcome was defined as 50%decline in eGFR or ESRD.We compare two groups:with crescents(N=24,27%)and with no crescents.

Results

The baseline characteristics were similar between the groups.The patients with C had more proteinuria and hypoalbuminemia at presentation but had similar eGFR.Endocapillary hypercellularity and segmental glomerulosclerosis lesions were higher in patients with crescents(P<0.02).During a mean follow-up of 55.4months,50% of the patients with crescents reached the composite outcome compared with27%of patients without(P<0.05).Survival curves are presented.
ESRD were more likely in the first group(P<0.02) and50% decline in eGFR was more frequent but was not statistically significant.The independent predictors of composite outcome were eGFR at presentation, proteinuria,presence of crescents and moderate to severe interstitial fibrosis and tubular atrophy. In a multivariable Cox analysis,crescents(HR3.33,CI95%1.24-8.90,p<0.02),eGFR(HR0.16,p<0.001) and no immunosuppressive therapy(IST) (HR3.23,p<0.05)were associated with an increased risk of developing the composite outcome.IST was based on corticosteroid therapy,in 4cases prednisolone and cyclophosphamide were administrated.The survival at 96months in patients without IST was71%if they had no crescents and 42% if had any crescent(P=0.022).The survival among those that were treated with IST was 80% if had no crescents (vs51%,P=0.124).

Conclusion

Crescents,along with higher eGFR at presentation,were an independent prognostic factor in our population.The main histologic alterations associated with the outcome were severe interstitial fibrosis,tubular atrophy and crescents.Our study suggests that crescent have value in predicting renal outcomes in our population with IgAN.