Volume of Crescents Affects Prognosis of IgA Nephropathy in Patients without Obvious Chronic Renal Pathology

Lin, Zaoqiang; Liu, Lichang; Zhang, Rongling; Lin, Xun; Lu, Fuhua; Bao, Kun; Wang, Lixin; Lin, Qian; Mai, Jianling; Cao, Yangsen; Yang, Haifeng; Liu, Xusheng; Zou, Chuan

doi:10.1159/000516187

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…Low serum levels of complement C3 is often associated with poor renal outcomes in IgAN [ 23 ]. Consistent with our previous study, global crescent and Serum C3 are the independent risk factor for IgAN progression and poor renal outcome in IgAN patients without significant chronic kidney damage [ 24 ]. Further more, Latest study show that crescent is independently associated with higher mortality in IgAN [ 25 ].…”

Section: Discussionsupporting

confidence: 91%

Prediction of prognosis in immunoglobulin a nephropathy patients with focal crescent by machine learning

et al. 2022

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Background and objectives Immunoglobulin a nephropathy (IgAN) is the most common primary glomerular disease in the world, with different clinical manifestations, varying severity of pathological changes, common complications of crescent formation in different proportions, and great individual heterogeneous in clinical outcomes. Therefore, we aim to develop a machine learning (ML) based predictive model for predicting the prognosis of IgAN with focal crescent formation and without obvious chronic renal lesions (glomerulosclerosis <25%). Materials We retrospectively reviewed biopsy-proven IgAN patients in our hospital and cooperative hospital from 2005 to 2017. The method of feature importance of random forest (RF) was applied to conduct feature exploration of feature variables to establish the characteristic variables that are closely related to the prognosis of focal crescent IgAN. Multiple ML algorithms were attempted to establish the prediction models. The area under the precision-recall curve (AUPRC) and the area under the receiver operating characteristic curve (AUROC) were applied to evaluate the predictive performance via three-fold cross validation (namely 2 training sets and 1 validation set). Results RF was used to screen the important features, the top three of which were baseline estimated glomerular filtration rate (eGFR), serum creatine and triglyceride. Ten important features were selected as important predictors for modeling on the basis of data-driven and medical selection, predictors include: age, baseline eGFR, serum creatine, serum triglycerides, complement 3(C3), proteinuria, mean arterial pressure (MAP) and Hematuria, crescents proportion of glomeruli, Global crescent proportion of glomeruli. In a variety of ML algorithms, the support vector machine (SVM) algorithm displayed better predictive performance, with Precision of 0.77, Recall of 0.77, F1-score of 0.73, accuracy of 0.77, AUROC of 79.57%, and AUPRC of 76.5%. Conclusions The SVM model is potentially useful for predicting the prognosis of IgAN patients with focal crescent shape and without obvious chronic renal lesions.

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Section: Discussionsupporting

confidence: 91%

Prediction of prognosis in immunoglobulin a nephropathy patients with focal crescent by machine learning

et al. 2022

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“…The results from this study showed that, complement hyper-activation may be involved in the development of extra-capillary proliferation, notably diffuse crescent formation, in these patients (33). More recently, volume of crescents was investigated by Lin et al, to evaluate the prognosis of IgAN in individuals without chronic morphologic lesions on renal biopsy (35). This study included 305 biopsy-proven IgAN patients.…”

Section: Significance Of Crescents In Igan (Mest-c Scores)mentioning

confidence: 83%

“…On multivariate analysis, the GC group was associated with an increased risk (HR = 2.756, 95% CI = 1.068-7.109) of adverse outcome. They concluded that global crescents can be an independent risk factor for the development of progressive kidney failure in IgAN (35). In summary, Oxford classification of IgAN has proved to be an independent and earlier risk stratification parameter for patients with IgAN and when combined with clinical and laboratory features at the time of diagnosis, it can achieve accurate risk assessment two years earlier than methods used in current clinical practice.…”

Section: Significance Of Crescents In Igan (Mest-c Scores)mentioning

confidence: 99%

Risk stratification and long-term kidney survival in IgA nephropathy with particular emphasis on Oxford classification; A narrative review

Hechanova

Mubarak

Jahangiri³

et al. 2022

J Nephropathol

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Introduction: IgA nephropathy (IgAN) is one of the most common forms of glomerulonephritis worldwide. It leads to end-stage renal disease (ESRD) in many patients. At the time of diagnosis, risk stratification is of paramount importance in planning proper management in individual cases. Several studies have been conducted to determine the utility of various demographic, clinical, laboratory, and pathological features on renal biopsy to stratify the risk of disease progression and predict the likely outcome. This review summarizes the emerging data on demographic, clinical, laboratory, and histological prognosis along with risk factors associated with renal outcomes in patients with IgAN. Methods: For this review, we searched DOAJ (Directory of Open Access Journals), PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar, using keywords including; "IgA nephropathy," "IgA nephritis," "IgAN," "Berger’s disease," "Berger’s syndrome," "chronic glomerulonephritis, "prognostic factors," "risk factors," "risk stratification," "renal survival," "ESRD," "MEST classification," "MEST-C classification" and "Oxford Classification." To identify other relevant studies, we manually scanned the bibliographic lists of the identified studies and reviewed articles from January 2009 through December 2020. All relevant articles were carefully reviewed, and relevant information was extracted for this narrative review. Results: A total of 152 articles were retrieved from the above literature database searches. The abstracts were carefully reviewed to identify 35 articles containing information on prognostic factors and longterm renal survival in IgAN patients. Relevant information was collected and summarized for this review. The main focus was on using demographic, clinical, and laboratory features, especially serial changes in these parameters during follow-up, for this purpose. Recently a standardized, evidencebased formulation has been devised to evaluate and categorize pathological features on renal biopsy to augment and refine the risk stratification and prognostic value of traditional risk factors; it is popularly known as the Oxford classification of IgAN. There have been numerous validation studies in various ethnic groups that have proven its clinical utility. Conclusion: In conclusion, the clinicians should also take into account the pathologic variables according to the revised Oxford classification in addition to demographic, clinical, and laboratory parameters for early and reliable risk stratification and prognostication in individual patients at the time of diagnosis in IgAN for optimal management and ultimate improvement in long-term outcomes.

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“…They are more often hypertensive, have higher levels of serum creatinine (with lower eGFR), higher levels of proteinuria, and more advanced renal disease at biopsy (i.e., GS and SS and IFTA) [14,20,26,29,31]. As a result, it has been shown that they are 1.5-3.0 times more likely to progress to ESKD compared with patients without crescents [8,13,14,29,30]. Not unexpectedly, the prognosis in IgAN patients with crescents is related to the proportion of glomeruli with crescents.…”

Section: Discussionmentioning

confidence: 99%

“…As seen in our study, overall, crescents involve ≤25% of glomeruli in 20-40% of patients with only 2-14% of patients having lesions in >25% of glomeruli [13,15,[23][24][25][26], while the presence of crescents involving ≥50% of glomeruli is an even more infrequent, seen in <2% of patients with IgAN [21,27,28]. While the poor prognosis associated with "diffuse crescents" has been well demonstrated, it has now been shown that the presence of crescents in even a smaller proportion of glomeruli can portend a poor prognosis [8,13,14,29,30].…”

Section: Discussionmentioning

confidence: 99%

IgA Nephropathy with Crescents: A Single-Center Experience

Ramani¹,

Whittier²,

Korbet³

2022

Am J Nephrol

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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.

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Volume of Crescents Affects Prognosis of IgA Nephropathy in Patients without Obvious Chronic Renal Pathology

Cited by 8 publications

References 24 publications

Prediction of prognosis in immunoglobulin a nephropathy patients with focal crescent by machine learning

Prediction of prognosis in immunoglobulin a nephropathy patients with focal crescent by machine learning

Risk stratification and long-term kidney survival in IgA nephropathy with particular emphasis on Oxford classification; A narrative review

IgA Nephropathy with Crescents: A Single-Center Experience

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