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The Added Value of Crescents on Oxford Classification Score in Risk Stratification of End-stage Kidney Disease in

Shahrzad Ossareh1, Neda Nazemzadeh, Mojgan Asgari

  • 1Department of Medicine, Nephrology section), Iran University of Medical Sciences (IUMS), Hasheminejad Kidney Center (HKC), Tehran, Iran. ossareh_s@hotmail.com.

Iranian Journal of Kidney Diseases
|April 30, 2022
PubMed

Insights

The presence of crescents (C) and tubular atrophy/interstitial fibrosis (T) independently predict end-stage kidney disease (ESKD) in IgA nephropathy (IgAN) patients. High risk of ESKD is associated with combined T1 and C1 scores.

Area of Science:

  • Nephrology
  • Pathology
  • Immunology

Background:

  • IgA nephropathy (IgAN) is a common glomerular disease.
  • The Oxford classification (MEST score) aids prognostication.
  • Crescents (C) are a recent addition to the Oxford classification.

Purpose of the Study:

  • To evaluate the impact of crescents (C) on end-stage kidney disease (ESKD) development in IgAN patients.
  • To assess the added prognostic value of crescents to the MEST score.

Main Methods:

  • 115 IgAN patients were followed for a mean of 43 months.
  • MEST score components were assessed: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), and tubular atrophy/interstitial fibrosis (T).
  • Crescents (C) were defined as C0 (absent) or C1 (present); T was defined as T0 (≤25%) or T1 (>25%).

Main Results:

  • 40 patients (35%) developed ESKD.
  • Crescents ≥ 30% (C1) and T1 were independently associated with increased ESKD risk (HR=3.15 and HR=7.18 respectively).
  • The combined presence of T1 and C1 significantly increased ESKD risk (74% developed ESKD).

Conclusions:

  • Tubular atrophy/interstitial fibrosis (T ≥ 25%) and crescents (≥ 30%) are independent predictors of ESKD in IgAN.
  • The combination of T1 and C1 signifies a high risk for ESKD.
  • These findings refine prognostication in IgAN patients.
Abstract

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