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IgA Nephropathy with Crescents: A Single-Center Experience
Nirali Ramani1, William L Whittier1, Stephen M Korbet1
1Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
American Journal of Nephrology
|January 11, 2023
Summary
Crescents in IgA nephropathy (IgAN) did not worsen outcomes like end-stage kidney disease (ESKD). Aggressive immunosuppressive treatment and limited crescent involvement in most patients likely contributed to these findings.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Crescents in IgA nephropathy (IgAN) are traditionally linked to a poor prognosis.
- Assessing the prognostic significance of crescents in IgAN is crucial for patient management.
Purpose of the Study:
- To evaluate the prognostic impact of crescents in patients diagnosed with IgA nephropathy.
- To determine if the presence and extent of crescents correlate with kidney disease progression.
Main Methods:
- Retrospective analysis of 73 IgA nephropathy patients biopsied between 1992 and 2020.
- Collected clinical, laboratory, histological data, treatment, and end-stage kidney disease (ESKD) outcomes.
- Compared outcomes between patients with and without crescents, with statistical significance set at p < 0.05.
Main Results:
- Patients with crescents showed higher proteinuria (UPro/Cr ratio) but similar hypertension, serum creatinine (SCr), and estimated glomerular filtration rate (eGFR) at biopsy.
- Histological features like sclerosis and interstitial fibrosis were comparable between groups.
- Despite a higher rate of immunosuppressive treatment in the crescent group (70% vs. 21%), end-stage kidney disease (ESKD) rates (19% vs. 23%) and 10-year renal survival (80% vs. 74%) were similar.
Conclusions:
- The presence of crescents in IgA nephropathy (IgAN) was not associated with an increased risk of progression to end-stage kidney disease (ESKD) in this cohort.
- Limited crescent involvement (<25% of glomeruli) and aggressive immunosuppressive therapy may explain the favorable outcomes observed.
- These findings suggest that crescents in IgAN may not always portend a poor prognosis, especially with appropriate management.
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