Ossareh Shahrzad, Nazemzadeh Neda, Asgari Mojgan, Bagherzadegan Hadia, Afghahi Hanri
Department of Medicine, Nephrology section), Iran University of Medical Sciences (IUMS), Hasheminejad Kidney Center (HKC), Tehran, Iran.
Iran J Kidney Dis. 2022 Mar;16(2):115-124.
Crescents (C) have been recently added to the Oxford classification of IgA nephropathy (IgAN) consisting of mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S) and tubular atrophy/ interstitial fibrosis (T) (MEST). The aim of the study was to assess the added impact of crescents, on development of end-stage kidney disease (ESKD) in IgAN patients Methods. On-hundred fifteen IgAN patients (76% male, mean age: 37 ± 13 years, mean serum creatinine: 4.0 ± 4.3 mg/dL, mean proteinuria: 3.4 ± 2.5 g/d) were followed for 43 ± 29 months. MEST score was defined according to Oxford classification (M0/M1, E0/ E1, S0/S1). To increase the power, T was defined as T0 ≤ 25% and T1 > 25%. Crescents were defined as C0, "absence" and C1 "at least one" crescent. In sensitivity analysis, the risk of ESKD was estimated at different cut-off levels of at least 10, 20, and 30% crescents.
Forty patients (35%) developed ESKD. Among those 14% with at least one crescent, 21 patients (46%) developed ESKD. In 11 patients with C ≥ 30%, 66% and among 57 patients with T1, 60% and in 27 patients with T1 + C1 74% developed ESKD. In adjusted model, only C ≥ 30% (HR = 3.15, 95% CI: 1.15 to 11.00; P = 0.027) and the presence of T1+ C1 (HR = 7.18, 95% CI: 1.90 to 27.10, P = 0.004) were associated with increased risk of ESKD. The median kidney survival was 78.0 months (95% CI: 70.5 to 85.6 months), in patients with T0 + C0 and 32.3 months (95% CI: 19.3 to 45.3 months) in patients with T1 + C1.
In this study T ≥ 25%, and the presence of crescents ≥ 30%, were independently associated with increased risk of ESKD. This risk was strongly increased in the combined presence of at least one crescent and T1 ≥ 25%, that predicted a high ESKD rate. DOI: 10.52547/ijkd.6685.
最近，新月体（C）已被纳入IgA肾病（IgAN）的牛津分类，该分类包括系膜细胞增生（M）、毛细血管内细胞增生（E）、节段性硬化（S）和肾小管萎缩/间质纤维化（T）（MEST）。本研究的目的是评估新月体对IgAN患者终末期肾病（ESKD）发展的额外影响。方法：对115例IgAN患者（76%为男性，平均年龄：37±13岁，平均血清肌酐：4.0±4.3mg/dL，平均蛋白尿：3.4±2.5g/d）进行了43±29个月的随访。根据牛津分类定义MEST评分（M0/M1，E0/E1，S0/S1）。为了提高检验效能，将T定义为T0≤25%和T1>25%。新月体定义为C0，“无”和C1“至少一个”新月体。在敏感性分析中，在新月体至少为10%、20%和30%的不同临界值水平下估计ESKD的风险。
40例患者（35%）发展为ESKD。在那些至少有一个新月体的患者中，14%的患者中有21例（46%）发展为ESKD。在C≥30%的11例患者中，66%发展为ESKD，在T1的57例患者中，60%发展为ESKD，在T1 + C1的27例患者中，74%发展为ESKD。在调整模型中，只有C≥30%（HR = 3.15，95%CI：1.15至11.00；P = 0.027）和T1 + C1的存在（HR = 7.18，95%CI：1.90至27.10，P = 0.004）与ESKD风险增加相关。T0 + C0患者的中位肾脏生存期为78.0个月（95%CI：70.5至85.6个月），T1 + C1患者为32.3个月（95%CI：19.3至45.3个月）。
在本研究中，T≥25%以及新月体≥30%的存在与ESKD风险增加独立相关。在至少有一个新月体和T1≥25%同时存在的情况下，这种风险会显著增加，这预示着ESKD的高发生率。DOI：10.52547/ijkd.6685
