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Abstract: TH-PO1030

The Predictive Value of Crescents in Adult Henoch-Schölein Purpura Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Author

  • Han, Fei, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, ZheJiang, China
Background

To study the predictive value of crescents in adult Henoch-Schölein purpura nephritis(HSPN).

Methods

We retrospectively analyzed 275 adult patients with biopsy proven HSPN in the First Affiliated Hospital of Zhejiang University, and divided the patients into 4 groups: 99 patients in none crescent croup(NC), 34 patients in segmental crescents group(SC), 109 patients with circumferential crescents ≤25% were categorized into group C1, and 33 patients with crescents >25% were categorized into group C2. Data including serum creatinine(Scr), evaluated glomerular filtration rate(eGFR), 24h urine protein and mean arterial pressure were compared, and primary outcome was defined as ≥50% reduction of eGFR from baseline in 2 years, doubling of serum creatinine (Scr), or end stage renal disease (ESRD). ESRD was defined by reaching an eGFR of <15ml/min/1.72m2 or requiring maintaining renal replacement therapy for more than 3 months. Univariate analysis and multivariate analysis were used to compare the outcome.

Results

There were no significant difference in gender or age(p>0.05). Differences in Scr(p=0.002), eGFR(p=0.007), 24h urine protein (p<0.001)were found significant. The median Scr level of NC, C1,C2, SC group were 59.0(51.0, 75.0)μmol/L,66.0(52.5, 77.0)μmol/L, 72.0 (55.0, 94.0) μmol/L, 68.0(56.5,118.0) μmol/L, respectively. Further analysis showed that patients with crescents (including segmental crescents) have a higher Scr level than those without crescents. The urine protein level of each group were 0.75(0.42,1.53),1.17(0.63,2.02)g, 1.60(0.86,3.00)g, 2.48(1.12,4.63) g, respectively. The median follow-up duration was 56(33,85) months, and 18 patients reached renal endpoint. Kaplan Meier analysis suggested that the renal outcomes were significantly different(p=0.002), the renal survival rates of NC, C1, C2, SC group were 96%, 88.1%, 78.8%, 100%, respectively. And Cox model suggested that a crescent ratio of more than 25% is an independent predictor of poor renal outcome.

Conclusion

A crescent ratio of more than 25% is an independent predictor of poor renal outcome in adult patients with Henoch-Schölein purpura nephritis.