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Abstract: SA-PO904

Treatment Patterns and Outcomes in Crescentic IgA Nephropathy and Vasculitis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Saha, Manish K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Blazek, Lauren N., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Vu, Duy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Falk, Ronald, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Terinte-Balcan, George, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Moreno, Vanessa, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Hu, Yichun, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Mottl, Amy K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background

Treatment patterns and consequent outcomes in crescentic IgA Nephropathy (IgAN-C) and IgA vasculitis (IgAV-C) are unknown.

Methods

We conducted a retrospective chart review of adults with biopsy proven IgAN-C/IgAV-C registered in the Glomerular Disease Collaborative Network from 1996 to 2018. Treatments were categorized as: IV cyclophosphamide (CYC) + steroids OR mycophenolate (MMF) + steroids, steroids alone or conservative therapy (CT). Minimal treatment included 2 months of CYC and 4 months of MMF or steroids. Azathioprine or MMF were used in all cases for maintenance treatment following CYC and MMF induction therapy. MEST-C scoring was performed by a single nephropathologist. The composite kidney endpoint was a 40% decline in eGFR, ESKD or eGFR < 15ml/min/1.73m2.

Results

The baseline demographics, clinical characteristics and endpoints are shown in Table 1. Median duration of follow-up was 46 months (95% CI 20-84) in the full cohort and was statistically similar across treatment groups (p=0.8). The only baseline difference between groups was in the severity of mesangial hypercellularity (MH) and crescentic involvement. MH was numerically lowest in the CT group and ≥25% crescents was numerically greatest in CYC group. The composite kidney endpoint was common, occurring in 60 (65%) of the total sample. Outcomes were similar across treatment groups, though there was a numerically lower risk for the composite kidney endpoint in the CYC group.

Conclusion

CYC may be superior for treatment of IgAN-C/IgAV-C. A randomized clinical trial is indicated to inform optimal therapy for this high-risk population.

Table 1 Demographic features, laboratory characteristics, MEST-C score, and clinical endpoints among different treatment groups