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Clinical Significance of Crescent Formation in IgA Nephropathy - a Multicenter Validation Study

Title
Clinical Significance of Crescent Formation in IgA Nephropathy - a Multicenter Validation Study
Authors
Park, SehoonBaek, Chung HeePark, Su-KilKang, Hee GyungHyun, Hye SunPark, EujinHan, Seung HyeokRyu, Dong-RyeolKim, Dong KiOh, Kook-HwanJoo, Kwon WookKim, Yon SuMoon, Kyung ChulChin, Ho JunLee, Hajeong
Ewha Authors
류동열
SCOPUS Author ID
류동열scopus
Issue Date
2019
Journal Title
KIDNEY & BLOOD PRESSURE RESEARCH
ISSN
1420-4096JCR Link

1423-0143JCR Link
Citation
KIDNEY & BLOOD PRESSURE RESEARCH vol. 44, no. 1, pp. 22 - 32
Keywords
IgA nephropathyRenal prognosisCrescentEnd stage renal diseaseGlomerulonephritis
Publisher
KARGER
Indexed
SCI; SCIE; SCOPUS WOS
Document Type
Article
Abstract
Background/Aims: Additional validation study was warranted to confirm the clinical significance of C score, which was recently added to the Oxford classification for immunoglobulin A nephropathy (IgAN). Methods: We performed a multicenter retrospective cohort study in four hospitals in Korea. Patients who had biopsied glomeruli less than eight or inadequate follow-up information were excluded. Clinicopathologic parameters, including the degree of cellular or fibrocellular crescents, were collected and included in multivariable models for Cox regression analysis. The main outcome was a composite renal outcome, defined as a merge of progression to end-stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from baseline. Results: Among included 3,380 biopsy-confirmed IgAN patients, there were 664 (19.6%) patients with C1 and 60 (1.8%) patients with C2 scores in the study population. Although C0 and C1 patients shared similar baseline characteristics, C2 patients frequently had more clinicopathologic risk factors for poor prognosis of IgAN. Both C1 [adjusted HR 1.33 (1.11-1.58), P=0.002] and C2 [adjusted HR 2.24 (1.46-3.43), P<0.001] scores were associated with an increased risk of the composite outcome. C2 was a strong predictive parameter associated with both progression to ESRD and halving of eGFR, whereas C1 was mainly associated with the increased risk of halving of eGFR. Notably, the proportion of crescent showed a linear association with the risk of adverse renal outcome. Conclusion: The C score in the Oxford classification is a valid predictive parameter for IgAN prognosis. Additional clinical attention is necessary for IgAN patients with identified cellular or fibrocellular crescents. (C) 2019 The Author(s) Published by S. Karger AG, Basel
DOI
10.1159/000497808
Appears in Collections:
의과대학 > 의학과 > Journal papers
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