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Abstract: TH-PO492

The Significance of Crescents on the Clinical Features and Outcomes of Primary Immunoglobulin A Nephropathy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Du, Yongjing, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
  • Chen, Shasha, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
  • Wang, Wei, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
Background

It is still controversial whether the proportion of crescents below 50% can be an independent predictive risk factor for poor prognosis in IgAN patients.

Methods

We retrospectively analyzed biopsy-proven primary IgAN patients in Sichuan Provincial People’s Hospital from 2007 to 2019. The patients were divided into 5 groups based on crescent proportion as follows: 0 (n=647), <10% (n=221), 10% to 24% (n=272), 25% to 49% (n=80), and ≥50% (n=22). The primary endpoint was defined as ESKD, and the secondary endpoint was the combined renal endpoint (≥50% reduction in eGFR or ESKD).

Results

1242 patients with biopsy-proven IgAN were recorded. 47.9% had different proportions of crescents. Compared with the non-crescent group, patients in the crescent group had lower levels of hemoglobin and albumin, higher levels of blood urea nitrogen, 24h urinary protein and hematuria, a higher proportion of mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, and tubular atrophy/interstitial fibrosis (T1/T2) (p<0.05). During the median follow-up of 43 months (range 6-151), 63 individuals (7.0%) reached the primary outcome of ESKD and 99 patients (11.1%) reached the combined renal endpoint. 34 (7.5%), 21 (13.3%), 24 (12.2%), 14 (21.5%) and 6 (31.6%) patients reached the combined renal endpoint in the above five groups in crescents 0, <10%, 10~24%, 25~49% and ≥50%, respectively. Multivariate Cox regression showed that crescents ≥50% was an independent risk factor for the progression of ESKD and crescents ≥25% was an independent risk factor for the combined renal endpoint. 274 (62.6%) cases in the crescent group and 254 (55.7%) cases in the non-crescent group received immunosuppressive therapy. The risk of combined renal endpoint increased with the increase proportions of crescents in IgAN patients without immunosuppressive therapy (p<0.05). Crescents ≥25% was an independent risk factor for poor prognosis in IgAN patients receiving immunosuppressive therapy. The receiver operating characteristic curve showed that IgAN patients with crescents >43.7% had a higher risk of poor prognosis.

Conclusion

IgAN patients with crescents had more severe clinicopathological features and poorer prognosis. IgAN patients with crescents >43.7% had a higher risk of poor prognosis, even after receiving immunosuppressive therapy.