IgA Nephropathy with Crescents: A Single-Center Experience

Abstract

Introduction: The presence of crescents in IgA nephropathy (IgAN) has been associated with a poor prognosis. We assess the prognosis of crescents in our pts with IgAN. Methods: IgAN was diagnosed in 73 pts biopsied at Rush University Medical Center from 1992-2020 and crescents were seen in 26 (36%). Clinical, laboratory and histologic features at biopsy, and treatment and outcome (end stage kidney disease-ESKD) were collected retrospectively. Data is presented as mean±SD and a P value of <0.05 was significant. Results: There was no difference in hypertension, SCr or eGFR in pts with crescents compared to those without crescents but pts with crescents had higher UPro/Cr ratio (2.8±2.7 vs 1.7± 1.7g/g, P 0.04). The percentage of glomeruli with global and segmental sclerosis (32±25% vs 38±28%, P 0.35) and the proportion of interstitial fibrosis and tubular atrophy (22±20% vs 22±22%, P 0.76) was similar. Only 19% of pts with crescents had lesions involving >25% of glomeruli. A larger proportion of pts with crescents were treated with immunosuppressive agents (70% vs 21%, P 0.0005). After 8.4±7 yrs of follow-up, ESKD (19% vs 23%, P 0.77) and renal survival at 10 years (80% vs 74%, P 0.99) were similar in pts with and without crescents. Discussion/Conclusion: The presence of crescents in IgAN was not associated with an increased risk of progression to ESKD. This may be a result of the fact that the majority of our patients had crescents involving <25% of glomeruli and received aggressive treatment with immunosuppressive agents.