Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions

Neves, Precil Diego Miranda de Menezes; Pinheiro, Rafaela; Dias, Cristiane Bitencourt; Yu, Liang; Testagrossa, Leonardo de Abreu; Cavalcante, Lívia Barreira; Malheiros, Denise Maria Avancini Costa; Jorge, Lectícia Barbosa; Woronik, Viktoria

doi:10.1159/000507251

Cited by 4 publications

References 27 publications

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Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Wang

Huang

et al. 2021

Renal Failure

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Background: The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN. Methods: Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models. Results: Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87-2.00; p ¼ .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40-2.50; p < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58-0.79; p < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR. Conclusions: Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.

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Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Wang

Huang

et al. 2021

Renal Failure

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The predictive value and response to immunosuppressive therapy of IgA nephropathy patients with crescents in a large retrospective Chinese cohort

Guo

Shi

Zhou

et al. 2023

Clinical Kidney Journal

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Background The prognostic value and response to immunosuppressive therapy (IST) of patients with crescents in the different backgrounds of pathological presentations in IgA nephropathy (IgAN) is unclear. Methods 1262 IgAN patients were enrolled. Crescents (C, 0/1/2), fibrinoid necrosis (FN, 0/1) and endocapillary hypercellularity (E, 0/1) were integrated into different degrees of glomerular activity (0–4 points): mild (0), moderate (1–2), and severe (≥ 3). The effect of IST on patients with different glomerular activity score and chronic tubular and interstitial lesions (T, 0/1/2) were analyzed using Cox regression analysis. The kidney outcome was defined as eGFR declined ≥ 30% or ESKD. Results C2 was an independent risk factor for kidney outcomes (overall cohort: HR 1.85; 95% CI, 1.03–3.31; P = 0.040; T0 patients: HR 6.52; 95% CI, 2.92–14.54; P < 0.001; reference to C0) in those without IST, while HR decreased to 0.83 (95% CI, 0.54–1.27; P = 0.396) in overall cohort and 2.39 (95% CI, 1.00–5.67; P = 0.049) in T0 patients with IST. For patients with severe glomerular activity, IST reduced the risk of kidney outcomes by 70% in overall cohort (HR 0.30; 95% CI, 0.12–0.74; P = 0.009; reference to those without IST) and 86% in T0 patients (HR 0.14; 95% CI 0.04–0.54; P = 0.005; reference to those without IST). Conclusions IST could reduce the risk for kidney outcomes in IgAN patients with C2 and T0 lesion together, as well as in those with crescents and at least one other active lesion including FN and E1 lesion.

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Nomogram for the prediction of crescent formation in IgA nephropathy patients: a retrospective study

Lin,

Feng,

Zeng

et al. 2023

BMC Nephrol

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Background The 2017 Oxford classification of immunoglobulin A nephropathy (IgAN) recently reported that crescents could predict a worse renal outcome. Early prediction of crescent formation can help physicians determine the appropriate intervention, and thus, improve the outcomes. Therefore, we aimed to establish a nomogram model for the prediction of crescent formation in IgA nephropathy patients. Methods We retrospectively analyzed 200 cases of biopsy-proven IgAN patients. Least absolute shrinkage and selection operator(LASSO) regression and multivariate logistic regression was applied to screen for influencing factors of crescent formation in IgAN patients. The performance of the proposed nomogram was evaluated based on Harrell’s concordance index (C-index), calibration plot, and decision curve analysis. Results Multivariate logistic analysis showed that urinary protein ≥ 1 g (OR = 3.129, 95%CI = 1.454–6.732), urinary red blood cell (URBC) counts ≥ 30/ul (OR = 3.190, 95%CI = 1.590–6.402), mALBU ≥ 1500 mg/L(OR = 2.330, 95%CI = 1.008–5.386), eGFR < 60ml/min/1.73m2(OR = 2.295, 95%CI = 1.016–5.187), Serum IgA/C3 ratio ≥ 2.59 (OR = 2.505, 95%CI = 1.241–5.057), were independent risk factors for crescent formation. Incorporating these factors, our model achieved well-fitted calibration curves and a good C-index of 0.776 (95%CI [0.711–0.840]) in predicting crescent formation. Conclusions Our nomogram showed good calibration and was effective in predicting crescent formation risk in IgAN patients.

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Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions

Cited by 4 publications

References 27 publications

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

The predictive value and response to immunosuppressive therapy of IgA nephropathy patients with crescents in a large retrospective Chinese cohort

Nomogram for the prediction of crescent formation in IgA nephropathy patients: a retrospective study

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