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Clinical implication of crescentic lesions in immunoglobulin A nephropathy

 Mi Jung Lee  ;  Seung Jun Kim  ;  Hyung Jung Oh  ;  Kwang Il Ko  ;  Hyang Mo Koo  ;  Chan Ho Kim  ;  Fa Mee Doh  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Beom Jin Lim  ;  Hyeon Joo Jeong  ;  Seung Hyeok Han 
 Nephrology Dialysis Transplantation, Vol.29(2) : 356-364, 2014 
Journal Title
 Nephrology Dialysis Transplantation 
Issue Date
BACKGROUND: To date, there has been much controversy about the role of crescentic lesion as a significant prognostic factor in immunoglobulin A nephropathy (IgAN). This study evaluated whether crescentic lesions predict adverse renal outcomes in IgAN patients. METHODS: A total of 430 patients with biopsy-proven IgAN between January 2000 and December 2009 were included. Histological variables of the Oxford classification (Oxford-MEST) and the presence of crescents were assessed. The primary endpoint was a 50% decline in estimated glomerular filtration rate. RESULTS: Of the 430 patients, 81 (18.8%) had a crescentic lesion. During a mean follow-up of 61 months, the primary outcome occurred in 19 (23.5%) patients with crescents compared with 40 (11.5%) patients without crescents (P=0.01). A Kaplan-Meier plot showed that the 10-year renal survival rate was significantly lower in patients with crescents than patients without crescents (P=0.01). However, in a multivariable Cox analysis which included clinical factors and the Oxford-MEST, crescents were not significantly associated with an increased risk of developing the primary outcome [hazard ratio: 0.71, 95% confidence interval (CI) 0.36-1.41, P=0.33]. Furthermore, adding crescents to the Oxford-MEST did not improve the discriminative ability for the prediction of renal outcomes [c-statistic: 0.86 (0.81-0.91) vs. 0.86 (0.80-0.91), P=0.21]. CONCLUSION: Crescentic lesion was not an independent prognostic factor, suggesting that crescents have limited value in predicting renal outcomes of IgAN.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
고광일(Ko, Kwang Il)
구향모(Koo, Hyang Mo)
김승준(Kim, Seung Jun)
김찬호(Kim, Chan Ho)
도화미(Doh, Fa Mee) ORCID logo https://orcid.org/0000-0002-4780-6728
오형중(Oh, Hyung Jung)
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
이미정(Lee, Mi Jung)
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
최규헌(Choi, Kyu Hun) ORCID logo https://orcid.org/0000-0003-0095-9011
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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