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Kidney Week

Abstract: SA-PO465

Glomerular Crescents Are Associated with the Risk of Kidney Progression in Type 2 Diabetic Kidney Disease

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Bae, Sohyun, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Jhee, Jong Hyun, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Chang, Tae ik, Department of Internal Medicine, National Health Insurance Service Medical Center Ilsan Hospital, Ilsan, Korea (the Republic of)
  • Oh, Jieun, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Kim, Sung Gyun, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Chin, Ho Jun, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Han, Seung Seok, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
Background

Type 2 diabetic kidney disease (T2DKD) is the leading cause of chronic kidney disease and end-stage kidney disease. The heterogeneous phenotype of T2DKD complicates the approach to treating patients. While kidney biopsy is the gold standard for diagnosis, it is not perfect in predicting progression to end-stage kidney disease. Herein, we addressed whether the presence of glomerular crescents was associated with the outcomes in biopsy-proven T2DKD.

Methods

A total of 360 patients who were diagnosed as biopsy-proven DKD in the setting of type 2 diabetes but did not have other crescentic glomerulonephritis from 9 medical centers were reviewed. Hazard ratios (HRs) were calculated using a Cox regression model to evaluate the risk of kidney progression (i.e., ≥50% of decrease in estimated glomerular filtration rates) according to the presence of glomerular crescents.

Results

11 patients (3.1%) had glomerular crescents in the biopsied tissues. During the follow-up period (median, 18 months; maximum, 18 years), the crescent group had a higher risk of kidney progression than no crescent group with adjusted HR of 2.71 (1.22–6.03) (P = 0.014). The relationship with kidney progression was more prominent in patients with high proportion of crescents than in those with low proportion.

Conclusion

The presence of glomerular crescents is associated with progression of T2DKD. Accordingly, histological monitoring of glomerular crescents may be needed to treat patients intensively.

Fig 1. Kidney outcome curves for patients with and without crescents in the biopsied tissues. Kaplan-Meier curve depicted for patients without crescents versus those who had glomerular crescents in the biopsied tissues.