The Crescentic Implication of Renal Outcomes in Proliferative Lupus Nephritis

Cai, Fei; Han, Fei; Wang, Hongya; Han, Haidongqin; Le, Jingyun; Lan, Lan; Xü, Ying; Chen, Jianghua

doi:10.3899/jrheum.170553

Cited by 19 publications

(14 citation statements)

References 19 publications

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“…This study also investigated the histological characteristics of the E-LN and D-LN patients. Although previous studies have described that features such as crescent formation and chronic tubulointerstitial changes could have prognostic value in LN, 8, 16, 30 the extent of these parameters at baseline did not differ between the two groups. With regard to the ISN/RPS classification, we observed a higher prevalence of mixed proliferative and membranous LN (class III+V/IV+V) in the D-LN group than in the E-LN group.…”

Section: Discussioncontrasting

confidence: 62%

Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan

Nakano

Kubo

Shirota

et al. 2019

Lupus

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Objective The objective of this study was to investigate possible differences in treatment responses between two categories for the onset of lupus nephritis. Methods We performed a multicentre, retrospective cohort study of class III–V lupus nephritis patients diagnosed between 1997 and 2014. The renal responses to initial induction therapy were compared between patients who developed lupus nephritis within one year from diagnosis of systemic lupus erythematosus (early (E-) LN) and the remainder (delayed (D-) LN) using the Kaplan–Meier method. We determined the predictors of renal response as well as renal flares and long-term renal outcomes using multivariate Cox regression analyses. Results A total of 107 E-LN and 70 D-LN patients were followed up for a median of 10.2 years. Log-rank tests showed a lower cumulative incidence of complete response in D-LN compared with E-LN patients. Multivariate analysis identified D-LN (hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.33–0.70), nephrotic syndrome at baseline, and a chronicity index greater than 2 as negative predictors of complete response. D-LN patients were more likely to experience renal flares. D-LN (HR 2.54, 95% CI 1.10–5.83) and decreased renal function were significant predictors of chronic kidney disease at baseline. Conclusion D-LN was a predictor of poorer treatment outcomes, in addition to renal histology and severity of nephritis at lupus nephritis onset.

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Section: Discussioncontrasting

confidence: 62%

Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan

Nakano

Kubo

Shirota

et al. 2019

Lupus

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“…Besides, the multivariate Cox regression analysis revealed that anemia (Hb < 8.0 g/dl, HR = 4.8) and crescents (more than 30%, HR = 2.1) were independent risk factors for ESRD. These risk factors were also reported in recent studies from Asian LN patients [34][35][36].…”

Section: Discussionsupporting

confidence: 82%

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

et al. 2020

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Background: The long-term predictive ability of acute kidney injury (AKI) classification based on "Kidney Disease: Improving Global Outcomes"(KDIGO) AKI diagnosis criteria has not been clinically validated in diffuse proliferative lupus nephritis (DPLN) patients with AKI. Our objective was to assess the long-term predictive value of KDIGO AKI classification in DPLN patients with AKI. Methods: Retrospective cohort study was conducted by reviewing medical records of biopsy-proven DPLN patients with AKI from the First Affiliated Hospital of Wenzhou Medical University between Jan 1, 2000 and Dec 31, 2014. Multivariate Cox regression and survival analysis were performed. Results: One hundred sixty-seven DPLN patients were enrolled,82(49%) patients were normal renal function (No AKI), 40(24%) patients entered AKI-1 stage (AKI-1), 26(16%) patients entered AKI-2 stage (AKI-2) and 19(16%) patients entered AKI-3 stage (AKI-3). The mean follow-up of all patients was 5.1 ± 3.8 years. The patient survival without ESRD of all patients was 86% at 5 years and 79% at 10 years. The patient survival rate without ESRD at 10 yr was 94.5% for No AKI patients, 81.8% for AKI-1 patients, 44.9% for AKI-2 patients and 14.6% for AKI-3 patients. The area under the ROC curve for KDIGO AKI classification to predict the primary end point was 0.83 (95% CI: 0.73-0.93) (P < 0.001). In Cox regression analysis, AKI stage was independently associated with primary endpoint, with an adjusted hazard ratio (HR) of 3.8(95% CI 2.1-6.7, P < 0.001). Conclusion: Severity of AKI based on KDIGO AKI category was associated with progression to ESRD in DPLN patients. Analytical data also confirmed the good discriminative power of the KDIGO AKI classification system for predicting long-term prognosis of DPLN patients with AKI.

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“…Studies of adult lupus patients have culminated in the use of 25% and 50% thresholds for both cellular and fibrous crescents in pathologic indices [ 25 , 29 , 30 , 31 ]. In 172 and 406 adults with lupus nephritis and crescents, each 1% increase in crescents corresponded to 2–4% increased risk of ESKD or doubling of serum creatinine [ 32 , 33 ]. Unfortunately, however, similar studies of 40, 78, and 101 pediatric patients with IgA vasculitis and GN with crescents failed to validate the proposed International Study of Kidney Disease in Children (ISKDC) classification thresholds for crescents, due to small sample sizes [ 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Renal Survival in Children with Glomerulonephritis with Crescents: A Pediatric Nephrology Research Consortium Cohort Study

Maliakkal

Hicks

Michael

et al. 2020

JCM

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There is no evidence-based definition for diagnosing crescentic glomerulonephritis. The prognostic implications of crescentic lesions on kidney biopsy have not been quantified. Our objective was to determine risk factors for end-stage kidney disease (ESKD) in patients with glomerulonephritis and crescents on kidney biopsy. A query of the Pediatric Nephrology Research Consortium’s Pediatric Glomerulonephritis with Crescents registry identified 305 patients from 15 centers. A retrospective cohort study was performed with ESKD as the primary outcome. Median age at biopsy was 11 years (range 1–21). The percentage of crescents was 3–100% (median 20%). Etiologies included IgA nephropathy (23%), lupus (21%), IgA vasculitis (19%) and ANCA-associated GN (13%), post-infectious GN (5%), and anti-glomerular basement membrane disease (3%). The prevalence of ESKD was 12% at one year and 16% at last follow-up (median = 3 years, range 1–11). Median time to ESKD was 100 days. Risk factors for ESKD included %crescents, presence of fibrous crescents, estimated GFR, and hypertension at biopsy. For each 1% increase in %crescents, there was a 3% decrease in log odds of 1-year renal survival (p = 0.003) and a 2% decrease in log odds of renal survival at last follow-up (p < 0.001). These findings provide an evidence base for enrollment criteria for crescentic glomerulonephritis in future clinical trials.

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The Crescentic Implication of Renal Outcomes in Proliferative Lupus Nephritis

Abstract: PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.

Cited by 19 publications

References 19 publications

Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan

Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

Renal Survival in Children with Glomerulonephritis with Crescents: A Pediatric Nephrology Research Consortium Cohort Study

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