Trimarchi Hernán, Haas Mark, Coppo Rosanna
Nephrology Service, Hospital Britanico de Buenos Aires, Buenos Aires C1280 AEB, Argentina.
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Clin Med. 2022 Jun 21;11(13):3569. doi: 10.3390/jcm11133569.
IgA nephropathy (IgAN) is a progressive disease with great variability in the clinical course. Among the clinical and pathologic features contributing to variable outcomes, the presence of crescents has attracted particular interest as a distinct pathological feature associated with severity. Several uncontrolled observations have led to the general thought that the presence and extent of crescents was a prognostic indicator associated with poor outcomes. However, KDIGO 2021 guidelines concluded that either the presence or the relative number of crescents should not be used to determine the progression of IgAN nor should they suggest the choice of immunosuppression. Our aim is to report and discuss recent data on the debated issue of the value of active (cellular and fibrocellular) crescents in the pathogenesis and clinical progression of IgAN, their predictive value, and the impact of immunosuppression on renal function. We conclude that the value of crescents should not be disregarded, although this feature does not have an independent predictive value for progression in IgAN, particularly when considering immunosuppressed patients. An integrated overall evaluation of crescents with other active MEST scores, clinical data, and novel biomarkers must be considered in achieving a personalized therapeutic approach to IgAN patients.
IgA肾病（IgAN）是一种临床病程差异很大的进行性疾病。在导致不同预后的临床和病理特征中，新月体的存在作为一种与疾病严重程度相关的独特病理特征引起了特别关注。一些非对照观察结果使人们普遍认为新月体的存在及其范围是与不良预后相关的预后指标。然而，KDIGO 2021指南得出结论，新月体的存在或相对数量既不应被用于确定IgAN的进展，也不应作为免疫抑制治疗选择的依据。我们的目的是报告和讨论关于活跃（细胞性和纤维细胞性）新月体在IgAN发病机制和临床进展中的价值、其预测价值以及免疫抑制对肾功能影响这一备受争议问题的最新数据。我们得出结论，新月体的价值不应被忽视，尽管该特征对IgAN的进展没有独立的预测价值，尤其是在考虑接受免疫抑制治疗的患者时。在实现对IgAN患者的个性化治疗方法时，必须综合考虑新月体与其他活跃的MEST评分、临床数据和新型生物标志物进行全面评估。
