Abstract: PO1587
Segmental Necrotizing/Crescentic Glomerulonephritis (SNGN) in IgA Nephropathy (IgAN): A Single-Center Experience
Session Information
- Glomerular Diseases: Clinicopathological Features and Outcomes in IgAN, Lupus Nephritis, and Vasculitis
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Ramani, Nirali Babubhai, Rush University Medical Center, Chicago, Illinois, United States
- Whittier, William Luke, Rush University Medical Center, Chicago, Illinois, United States
- Korbet, Stephen M., Rush University Medical Center, Chicago, Illinois, United States
Background
The presence of SNGN on renal biopsy generally portends a poor prognosis with rapidly progressive disease. We evaluate the presentation and outcomes of pts with IgAN to determine if the presence of SNGN portends a poorer prognosis in this pt population.
Methods
Biopsies done at Rush University Medical Center from 1992-2019, found IgAN in 73 pts in whom follow-up (FU) was available. SNGN was seen in 26 pts (36%). Clinical, laboratory, histologic features at biopsy, treatment and outcome data (doubling of SCr and ESKD) were collected retrospectively. Pts with and without SNGN were compared. Data is presented a mean±SD and a P value of <0.05 was significant.
Results
At biopsy there was no difference in age (42±16 vs 43±17 yrs), gender (54% vs 43% male), race or SCr (1.7±1.1 vs 1.6±1.1 mg/dl) in pts with compared to those without SNGN. Pt with SNGN had higher systolic BPs (140±14 vs 131±17 mmHg, P 0.02) and higher UPro/Cr ratio (2.8±2.7 vs 1.7± 1.7 g/g, P 0.04). All 15 SNGN pts tested were ANCA negative. The percent of glomeruli with global (GS)+segmental (SS) sclerosis (32±25 vs 38±28%) and interstitial fibrosis+tubular atrophy (IFTA) (22±20 vs 23±22%) was similar for those with vs without SNGN. In pts with SNGN, only 15% had lesions involving >25% of glomeruli. FU was similar on average (7±6 vs 8±7 yrs) in pts with and without SNGN and treatment with ACEi/ARBs was similar (88 vs 100%). A larger proportion of pts with SNGN were treated with immunosuppressive agents (69 vs 21%, P 0.003). At FU, doubling of SCr (25 vs 22%), ESKD (19 vs 21%) and renal survival at 10 yrs (80 vs 76%) were similar in pts with and without SNGN. In both groups, pts that progressed to ESKD had a higher proportion of glomeruli with GS+SS (SNGN: 63±16 vs 24±21%, P 0.002 and No SNGN: 64±27 vs 31±24%, P 0.002) and IFTA (SNGN: 47±19 vs 16±16%, P 0.006 and No SNGN: 41±27 vs 17±18%, P 0.01). In pts with SNGN, the proportion of glomeruli with SNGN was similar in those with and without ESKD (16±14 vs 18±17%).
Conclusion
In pts with IgAN, the presence of SNGN is frequently seen but does not alter prognosis. This may be the result of <25% involvement with SNGN lesions in the majority of our pts and more aggressive treatment in pts with SNGN. The presence of advanced GS+SS and IFTA at biopsy were most associated with progressive kidney disease rather than SNGN.