Wen Shan, Chen Shasha, Lin Yingying, Li Guisen, Zhang Ping, Wang Wei
Renal Department and Nephrology Institute, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
BMC Nephrol. 2025 Jan 14;26(1):24. doi: 10.1186/s12882-024-03923-1.
The factors influencing diffuse crescentic glomerulonephritis renal survival and prognosis remain uncertain. Additionally, there's no literature on the clinical outcomes of IgA nephropathy, lupus nephritis, and IgA vasculitis nephritis in type II patients.
This study retrospectively examined 107 patients diagnosed with diffuse crescentic glomerulonephritis through biopsy. Analytical methods included Cox regression models and Kaplan-Meier survival analysis to assess the data.
Among the 107 enrolled patients, 12 patients had Type I diffuse crescentic glomerulonephritis, 70 patients had Type II, and 25 patients had Type III. The respective 5-year kidney survival rates were 0%, 57.5%, and 18.6% for type I, type II, and type III. Furthermore, among Type II patients, IgA nephropathy emerged as the most prevalent condition. The cumulative 5-year kidney survival rates were 50% for patients with IgA nephropathy, 64% for lupus nephritis, and 70% for Henoch-Schönlein purpura nephritis. A significant association between the risk of ESKD development and several factors was revealed by a multivariate Cox regression analysis: estimated glomerular filtration rate (P = 0.004), initial kidney replacement therapy (KRT) at presentation (P = 0.002), global glomerulosclerosis (P<0.001).
Type II diffuse crescentic glomerulonephritis was the most prevalent type in DCGN, and favors better renal prognosis than type I and III DCGN, in which IgA nephropathy was the most common entity of Type II DCGN. Additionally, estimated glomerular filtration rate, initial KRT at presentation and global glomerulosclerosis were identified as predictors of renal outcomes in diffuse crescentic glomerulonephritis.
影响新月体性肾小球肾炎肾脏存活及预后的因素仍不明确。此外，关于Ⅱ型患者中IgA肾病、狼疮性肾炎和IgA血管炎肾病的临床结局尚无相关文献报道。
本研究回顾性分析了107例经活检确诊为新月体性肾小球肾炎的患者。分析方法包括Cox回归模型和Kaplan-Meier生存分析以评估数据。
在107例入组患者中，12例为Ⅰ型新月体性肾小球肾炎，70例为Ⅱ型，25例为Ⅲ型。Ⅰ型、Ⅱ型和Ⅲ型的5年肾脏存活率分别为0%、57.5%和18.6%。此外，在Ⅱ型患者中，IgA肾病是最常见的疾病类型。IgA肾病患者的累积5年肾脏存活率为50%，狼疮性肾炎患者为64%，紫癜性肾炎患者为70%。多因素Cox回归分析显示，终末期肾病发生风险与几个因素之间存在显著关联：估计肾小球滤过率（P = 0.004）、就诊时开始肾脏替代治疗（KRT）（P = 0.002）、全球肾小球硬化（P<0.001）。
Ⅱ型新月体性肾小球肾炎是新月体性肾小球肾炎中最常见的类型，其肾脏预后优于Ⅰ型和Ⅲ型新月体性肾小球肾炎，其中IgA肾病是Ⅱ型新月体性肾小球肾炎最常见的类型。此外，估计肾小球滤过率、就诊时开始KRT以及全球肾小球硬化被确定为新月体性肾小球肾炎肾脏结局的预测因素。
