Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions
Open Access
- 1 May 2020
- journal article
- research article
- Published by S. Karger AG in Kidney and Blood Pressure Research
- Vol. 45 (3), 431-441
- https://doi.org/10.1159/000507251
Abstract
Background and Aim: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil. Methods: This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group). Results: We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2. Conclusion: Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.This publication has 27 references indexed in Scilit:
- TWEAK/Fn14 system and crescent formation in IgA nephropathyBMC Nephrology, 2015
- Prognostic factors for renal allograft survival in patients with immunoglobulin A nephropathy: A case control studyMolecular Medicine Reports, 2014
- IgA NephropathyThe New England Journal of Medicine, 2013
- Nefropatia por IgA: análise histológica e correlação clínico-morfológica em pacientes do Estado de Minas GeraisBrazilian Journal of Nephrology, 2012
- Validation Study of Oxford Classification of IgA NephropathyClinical Journal of the American Society of Nephrology, 2011
- Predictors of outcome in paediatric IgA nephropathy with regard to clinical and histopathological variables (Oxford classification)Nephrology Dialysis Transplantation, 2011
- The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classificationKidney International, 2009
- The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibilityKidney International, 2009
- Clinical value of renal biopsy in patients with asymptomatic microscopic hematuria with and without low-grade proteinuriaClinical Nephrology, 2004
- Epidemiologic data of renal diseases from a single unit in China: Analysis based on 13,519 renal biopsiesKidney International, 2004