Different Proportions Of Crescents Were Associated With Clinicopathologic Characteristic And Prognosis In IgA Nephropathy

Abstract:Objective To determine the clinicopathological features and outcomes of IgA nephropathy patients with different proportions of crescents.Methods A total of 270 patients,who were diagnosed as IgA nephropathy by renal biopsies from January 2010 to December 2016 in our hospital were enrolled.All patients were divided into 3 groups according to the optimal cutoff level of crescents proportion in the receiver operating characteristic curve(ROC)as follows:0%,<14%;?14%.The endpoint was defined as the doubling of baseline serum creatinine(SCr)and/or end-stage renal disease(ESRD).Kaplan-Meier curve and cox regression model were used to analysis the renal survival among three groups.Results Among the 270 patients,104 patients(38.5%)without any crescents,84 patients(31.1%)with crescents proportion<14%and 82 patients(31.4%)with crescents proportion ?14%.(1)Clinical characteristic:Patients with crescents proportion?14%was older and had higher level of systolic blood pressure and diastolic blood pressure,24-hour urine protein,serum uric acid level,more patients treated with RAS blocker,glucocorticoid and immunotherapy but lower eGFR,hemoglobin and serum albumin level than those with crescents proport ion<14%.(2)characteristic:Compared with those without crescents and crescent proportion<14%,patients with crescent proportion?14%also had higher proportion of global glomerulosclerosis,more endocapillary hypercellularity and severe tubulointerstitial lesions,higher degree of IgA and C3 depositions in renal.(3)Related analysis:systolic blood pressure and diastolic blood pressure,24-hour urine protein,serum uric acid level,use of glucocorticoid and immunotherapy,endocapillary hypercellularity,tubular atrophy/interstitial fibrosis,IgA and C3 depositions in renal were positive related to crescents proportion.Age,eGFR,hemoglobin,serum albumin level and use of RAS blocker were negative related to crescents proportions.(4)24-hour proteinuria,serum uric acid level,low hemoglobin level,endocapillary hypercellularity and renal C3 depositions were risk factors for crescents formation.Age,24-hour proteinuria,serum uric acid level,low hemoglobin level,crescents proportion and T1/T2 were risk factors for patients with eGFR<60ml/min/1.73m2.(5)Patients were followed-up for a median of 31.7±21 months,Kaplan-Meier analysis revealed that renal survival rate was significantly lower in patients with crescents proportion>14%compared with other groups.(P=0.001).But there was no significant difference between no crescent group and crescents proportion<14%group.(6)Cox regression analysis:univariate cox regression model showed that serum creatinine,hemoglobin level,24-hour proteinuria,serum uric acid level,hypertension,serum albumin level,crescents proportion,fibrous crescents,T1/2 were associated with prognosis.However,after adjusted several risks,just serum creatinine,hemoglobin level,serum uric acid level and T1/2 were significant associated with renal outcomes,multivariate cox analysis showed that there was no significant difference between crescents proportion and renal survival.Conclusions Patients with crescents proportion ?14%had sever clinicopathologic characteristics.Univariate cox analysis found that patients with crescents proportion ?14%were significantly associated with worse prognosis.However,no significant difference between crescents proportion and renal survival was found in multivariate cox analysis.