Universität zu Köln

Haas, Mark, Verhave, Jacobien C., Liu, Zhi-Hong, Alpers, Charles E., Barratt, Jonathan ORCID: 0000-0002-9063-7229, Becker, Jan U., Cattran, Daniel, Cook, H. Terence, Coppo, Rosanna, Feehally, John, Pani, Antonello, Perkowska-Ptasinska, Agnieszka, Roberts, Ian S. D., Soares, Maria Fernanda ORCID: 0000-0001-6231-8987, Trimarchi, Hernan, Wang, Suxia, Yuzawa, Yukio, Zhang, Hong, Troyanov, Stephan and Katafuchi, Ritsuko (2017). A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy. J. Am. Soc. Nephrol., 28 (2). S. 691 - 702. WASHINGTON: AMER SOC NEPHROLOGY. ISSN 1533-3450

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Abstract

The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a >= 50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean +/- SD eGFR of 78 +/- 29 ml/min per 1.73 m(2) and median (interquartile range) proteinuria of 1.2 (0.7-2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression. We propose adding the following crescent scores to the Oxford Classification: CO (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in over one fourth of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Haas, Mark UNSPECIFIED UNSPECIFIED UNSPECIFIED Verhave, Jacobien C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Liu, Zhi-Hong UNSPECIFIED UNSPECIFIED UNSPECIFIED Alpers, Charles E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Barratt, Jonathan UNSPECIFIED orcid.org/0000-0002-9063-7229 UNSPECIFIED Becker, Jan U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cattran, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Cook, H. Terence UNSPECIFIED UNSPECIFIED UNSPECIFIED Coppo, Rosanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Feehally, John UNSPECIFIED UNSPECIFIED UNSPECIFIED Pani, Antonello UNSPECIFIED UNSPECIFIED UNSPECIFIED Perkowska-Ptasinska, Agnieszka UNSPECIFIED UNSPECIFIED UNSPECIFIED Roberts, Ian S. D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Soares, Maria Fernanda UNSPECIFIED orcid.org/0000-0001-6231-8987 UNSPECIFIED Trimarchi, Hernan UNSPECIFIED UNSPECIFIED UNSPECIFIED Wang, Suxia UNSPECIFIED UNSPECIFIED UNSPECIFIED Yuzawa, Yukio UNSPECIFIED UNSPECIFIED UNSPECIFIED Zhang, Hong UNSPECIFIED UNSPECIFIED UNSPECIFIED Troyanov, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Katafuchi, Ritsuko UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-241798
DOI:	10.1681/ASN.2016040433
Journal or Publication Title:	J. Am. Soc. Nephrol.
Volume:	28
Number:	2
Page Range:	S. 691 - 702
Date:	2017
Publisher:	AMER SOC NEPHROLOGY
Place of Publication:	WASHINGTON
ISSN:	1533-3450
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GLOMERULAR-FILTRATION-RATE; OXFORD CLASSIFICATION; CLINICOPATHOLOGICAL CORRELATIONS; REPEAT-BIOPSY; VALIDATION; LESIONS Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24179