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Renal survival and risk factors in IgA nephropathy with crescents
Feng Ma1, Limin Liu1, Ruijuan Dong1
1Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
Insights
Crescents in IgA nephropathy (IgAN) are an independent risk factor for poor renal outcomes. Factors like age, proteinuria, and eGFR predict combined events in IgAN patients with crescents.
Area of Science:
- Nephrology
- Immunology
Background:
- IgA nephropathy (IgAN) is a common glomerular disease.
- The prognostic significance of crescents in Chinese IgAN cohorts remains unclear.
Purpose of the Study:
- To investigate the association between crescents and renal outcomes in Chinese IgAN patients.
- To identify risk factors for combined renal events in IgAN patients with crescents.
Main Methods:
- A retrospective review of 169 IgAN patients with crescents, matched 1:1 with IgAN patients without crescents.
- Combined events defined as a ≥50% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD).
- Multivariate Cox regression models were used to analyze risk factors.
Main Results:
- Crescents were an independent risk factor for combined events (HR=2.216, P=0.039) after adjusting for multiple variables.
- 17.2% of IgAN patients with crescents developed combined events.
- Age, proteinuria, eGFR, E1, T1-T2, and RAAS were significant baseline predictors; TA-P, persistent hematuria, and TA-MAP were time-varying predictors.
Conclusions:
- The presence of crescents independently predicts combined renal events in Chinese IgAN patients.
- Several clinical and pathological factors are identified as independent risk factors for adverse outcomes in IgAN patients with crescents.
Purpose:
The association between crescents and renal outcomes was inconsistent in a Chinese IgA nephropathy (IgAN) cohort, and limited research has investigated the prognosis of IgAN patients with crescents.
Methods:
Between January 2008 and January 2013, 169 consecutive IgAN patients with crescents in the Xijing Hospital, who were matched to IgAN patients without crescents at a 1:1 ratio by sex, age, eGFR, and proteinuria were reviewed. Combined events were defined by either a ≥ 50% reduction in eGFR or ESRD.
Results:
All patients were followed for a mean of 49.9 ± 26.0 months, and 41 (12.1%) patients had developed combined events. Five multivariate Cox regression models were created, and crescents was an independent risk factor for combined events. In model 5, crescents (HR = 2.216, 95% CI 1.040-4.345, P = 0.039) were notably associated with the risk of combined events after adjusting for age, sex, smoking, TA-P, persistent hematuria, and TA-MAP. Of the IgAN patients with crescents, 17.2% had developed combined events. In the baseline variables model, age, proteinuria, eGFR, E1, T1-T2, and RAAS had statistically significant associations with combined events in the multivariate Cox regression analyses. In the time varying variables model, TA-P, persistent hematuria, and TA-MAP were independent risk factors for combined events.
Conclusion:
We validated that the presence of crescents was an independent predictor of combined events in Chinese IgAN patients. Age, proteinuria, eGFR, E1, T1-T2, RAAS, TA-P, persistent hematuria, and TA-MAP were independent risk factors for combined events in IgAN patients with crescents.
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