대한신장학회

논문분류	춘계학술대회 초록집
제목	A clinical significance of crescent formation in IgA nephropathy
저자	Sehoon Park1, Dong Ki Kim1, Yon Su Kim1, Kyung Chul Moon2, Hee Gyung Kang3, Chung Hee Baek4, Su-Kil Park4, Seung Hyeok Han6, Ho Jun Chin5, Hajeong Lee1
출판정보	2018; 2018(1):
키워드	immunoglobulin A nephropathy \| chronic kidney disease \| crescent \| end stage renal disease \| pathology
초록	Objectives: Recent guideline updated the Oxford classification for pathologic findings of IgA nephropathy (IgAN), and clinical importance of crescent formation has been addressed. Still, additional validation of its significance is warranted. Methods: We conducted a multicenter retrospective cohort study. We collected information of IgAN patients in four tertiary referral hospitals, under the project by the Korean Glomerular Disease Study Group. The degree of crescent formation was stratified following the MEST-C scoring system (C0: 0%, C1: >0% and <25%, C2: ≥25%). Clinical outcomes were progression to end stage renal disease (ESRD) and halving of estimated glomerular filtration rate (eGFR) from the baseline value. Patients 1) who received kidney biopsy before electrical medical records were available, 2) without follow-up information, or 3) with number of biopsied glomeruli less than eight were excluded. Clinical outcomes were analyzed with the multivariable Cox regression analysis. Results: We studied a total of 3,222 biopsy-confirmed IgAN patients in the study with a median follow-up duration of 8.6 years. There were 750 (23.3 %) patients with identified crescents in their kidney biopsy, and 56 (1.7 %) patients had a C2 score. Patients with crescentic IgAN were tended to be older of age (P<0.001) and had higher mean arterial pressure (P<0.001) and lower baseline eGFR (P<0.001). When we assessed the prognosis, C2 lesion was independently associated with higher risk of ESRD (adjusted HR 2.037, 95% CI 1.254-3.309, P=0.004). Moreover, both C1 (adjusted HR 1.441, 95% CI 1.169-1.775, P<0.001) and C2 (adjusted HR 2.001, 95% CI 1.159-3.457, P=0.013) lesions were associated with worse prognosis in regards of halving of eGFR from baseline. Conclusions: Crescentic lesions in IgAN were confirmed to be associated with worse prognosis in a large cohort. Clinicians may consider close monitoring and develop appropriate clinical management for IgAN patients with crescent formation. patient prognosis according to C scores
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