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Clinical Research
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A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy

Mark Haas, Jacobien C. Verhave, Zhi-Hong Liu, Charles E. Alpers, Jonathan Barratt, Jan U. Becker, Daniel Cattran, H. Terence Cook, Rosanna Coppo, John Feehally, Antonello Pani, Agnieszka Perkowska-Ptasinska, Ian S.D. Roberts, Maria Fernanda Soares, Hernan Trimarchi, Suxia Wang, Yukio Yuzawa, Hong Zhang, Stéphan Troyanov and Ritsuko Katafuchi
JASN February 2017, 28 (2) 691-701; DOI: https://doi.org/10.1681/ASN.2016040433
Mark Haas
*Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California;
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Jacobien C. Verhave
†Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands;
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Zhi-Hong Liu
‡Department of Nephrology, National Clinical Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China;
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Charles E. Alpers
§Department of Pathology, University of Washington School of Medicine, Seattle, Washington;
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Jonathan Barratt
‖Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom;
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Jan U. Becker
¶Institute of Pathology, University Hospital of Cologne, Cologne, Germany;
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Daniel Cattran
**Department of Medicine and Toronto General Research Institute, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada;
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H. Terence Cook
††Centre for Complement and Inflammation Research, Department of Medicine, Imperial College, London, United Kingdom;
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Rosanna Coppo
‡‡Fondazione Ricerca Molinette, Nephrology, Dialysis, and Transplantation, Regina Margherita Hospital, Turin, Italy;
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John Feehally
‖Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom;
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Antonello Pani
§§Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy;
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Agnieszka Perkowska-Ptasinska
‖‖Department of Nephrology, Transplantation Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland;
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Ian S.D. Roberts
¶¶Department of Cellular Pathology, Oxford University Hospitals, Oxford, United Kingdom;
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Maria Fernanda Soares
***Department of Pathology, Federal University of Sao Paolo, Sao Paolo, Brazil;
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Hernan Trimarchi
†††Department of Nephrology, Nephrology Service and Kidney Transplant Unit, Hospital Británico de Buenos Aires, Buenos Aires, Argentina;
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Suxia Wang
‡‡‡Department of Pathology, Laboratory of Electron Microscopy, Pathological Centre and
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Yukio Yuzawa
§§§Department of Nephrology, Fujita Health University School of Medicine, Toyoake Aichi, Japan;
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Hong Zhang
‖‖‖Renal Division, Peking University First Hospital, Beijing, China;
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Stéphan Troyanov
¶¶¶Division of Nephrology, Department of Medicine, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and
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Ritsuko Katafuchi
****Kidney Unit, National Fukuoka Higashi Medical Center, Fukuoka, Japan
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This article has a correction. Please see:

  • Erratum - May 01, 2017

Abstract

The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a ≥50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean±SD eGFR of 78±29 ml/min per 1.73 m2 and median (interquartile range) proteinuria of 1.2 (0.7–2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression. We propose adding the following crescent scores to the Oxford Classification: C0 (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in over one fourth of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.

  • IgA nephropathy
  • glomerulonephritis
  • Renal pathology
  • Oxford classification
  • crescents
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (2)
Journal of the American Society of Nephrology
Vol. 28, Issue 2
February 2017
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A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy
Mark Haas, Jacobien C. Verhave, Zhi-Hong Liu, Charles E. Alpers, Jonathan Barratt, Jan U. Becker, Daniel Cattran, H. Terence Cook, Rosanna Coppo, John Feehally, Antonello Pani, Agnieszka Perkowska-Ptasinska, Ian S.D. Roberts, Maria Fernanda Soares, Hernan Trimarchi, Suxia Wang, Yukio Yuzawa, Hong Zhang, Stéphan Troyanov, Ritsuko Katafuchi
JASN Feb 2017, 28 (2) 691-701; DOI: 10.1681/ASN.2016040433

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A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy
Mark Haas, Jacobien C. Verhave, Zhi-Hong Liu, Charles E. Alpers, Jonathan Barratt, Jan U. Becker, Daniel Cattran, H. Terence Cook, Rosanna Coppo, John Feehally, Antonello Pani, Agnieszka Perkowska-Ptasinska, Ian S.D. Roberts, Maria Fernanda Soares, Hernan Trimarchi, Suxia Wang, Yukio Yuzawa, Hong Zhang, Stéphan Troyanov, Ritsuko Katafuchi
JASN Feb 2017, 28 (2) 691-701; DOI: 10.1681/ASN.2016040433
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Keywords

  • IgA nephropathy
  • glomerulonephritis
  • renal pathology
  • Oxford classification
  • crescents

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