Kidney Week

Abstract: SA-OR058

Clinical Significance of Crescent Formation in IgA Nephropathy – A Multicenter Validation Study

Session Information

• IgA Nephropathy and Lupus Nephritis
  October 27, 2018 | Location: 6E, San Diego Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Sehoon Park, MD

• Baek, Chung Hee, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)

Chung Hee Baek,

• Park, Su-Kil, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)

Su-Kil Park,

• Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)

Hee Gyung Kang,

• Hyun, Hyesun, St. Vincent's Hospital, The Catholic University College of Medicine,, Suwon, Korea (the Republic of)

Hyesun Hyun,

• Park, Eujin, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)

Eujin Park,

• Han, Seung Hyeok, Yonsei University College of Medicine, Seoul, Korea (the Republic of)

Seung Hyeok Han,

• Ryu, Dong-Ryeol, Ewha Womans University, Seoul, Korea (the Republic of)

Dong-Ryeol Ryu,

• Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Dong Ki Kim,

• Oh, Kook-Hwan, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Kook-Hwan Oh,

• Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Kwon Wook Joo,

• Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Yon Su Kim,

• Chin, Ho Jun, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)

Ho Jun Chin,

• Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hajeong Lee,

Group or Team Name

• Korean Glomerular Disease Study Group

Background

Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A (IgAN).

Methods

We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable model for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline.

Results

Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P<0.001] scores were associated with increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression of ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome.

Conclusion

The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents