Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil,
Pathology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
Kidney Blood Press Res. 2020;45(3):431-441. doi: 10.1159/000507251. Epub 2020 Apr 16.
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil.
This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group).
We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2.
Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.
免疫球蛋白 A 肾病（IgAN）是最常见的原发性肾小球疾病。最近，牛津分类法已经更新，将新月体作为预后不良的标志物。本研究的目的是评估巴西 IgAN 患者中细胞性新月体对预后的影响。
这是一项单中心回顾性分析，对 IgAN 患者的病历和肾活检进行了分析。肾活检结果根据修订后的牛津分类进行分类：系膜细胞增生、内皮下细胞增生（E）、节段性肾小球硬化（S）、肾小管萎缩或间质纤维化（T）和新月体形成（C）。我们评估了一个复合结局（进展为终末期肾病或肌酐翻倍）。我们比较了肾活检标本中有新月体（C1/C2 组）和无新月体（C0 组）的患者。
我们共评估了 111 例患者，其中 72 例（65.0%）为女性，80 例（72.0%）自我认定为白人，73 例（65.6%）为高血压患者，95 例（85.6%）有血尿。根据细胞性新月体病变的分布，患者分为：C0 组 80 例（72%）；C1 组 27 例（24.4%）；C2 组 4 例（3.6%）。111 例患者中有 33 例（29.72%）出现复合结局。与 C0 组相比，C1/C2 组高血压患者比例较高（p=0.04），血尿患者比例较高（p=0.03），血清肌酐升高（p=0.0007）和估算肾小球滤过率降低（p=0.0007）。C1/C2 组中 E1（p=0.009）、S1（p=0.001）或 T1/T2（p=0.03）分类的患者比例也较高。此外，C1/C2 组的平均随访时间较短（p<0.0001）。此外，C1/C2 组复合结局的发生率和时间均高于 C0 组（p=0.002 和 p=0.0014）。Cox 回归分析显示，S1、T1/T2 和 C1/C2 的牛津分类是复合结局的独立危险因素。
S1、T1/T2 或 C1/C2 的牛津分类是复合结局的独立危险因素，与以往研究结果一致。
