Related factors of crescents and prognosis in IgA nephropathy.

Abstract

IgA nephropathy (IgAN) has the highest prevalence among primary glomerular diseases worldwide, and crescent is a risk predictor of renal prognosis in IgAN. However, this is still controversial, and more research is needed to further confirm the importance of crescents in IgAN patients. So we aim to investigate the related factors and prognosis of IgAN with crescents. 178 patients diagnosed with IgAN by renal biopsy were selected into a crescent group (C group, C1: 0% < crescent proportion < 25%, C2: crescent proportion ≥ 25%) and a non-crescent group (C0 group). The clinical and renal pathology indexes were compared, and the progression of proteinuria and renal function were followed up. Compared with the C0 group, the C group revealed lower level of serum albumin, hemoglobin, serum C3, and IgA complements, higher level of 24-hour urine protein quantity and urine erythrocyte count. Statistical differences in the degree of mesangial hyperplasia and C3 complement deposition were found between the two groups. Logistic regression analysis showed that hemoglobin and C3 complement deposition (+ and + +) were independent related factors of crescents in IgAN. Cumulative renal survival rate in C2 was significantly lower than in C1 (χ2 = 5.532, p = 0.019). IgAN patients with more crescents (≥ 25%) (adjusted hazard ratio (AHR) = 4.905, 95% CI: 1.135 - 21.208, p = 0.0033) and platelets (AHR = 1.016, CI: 1.006 - 1.023, p = 0.001) were more likely to progress to the end event in Cox regression analysis. IgAN patients with crescents may have severe clinical symptoms and poor prognosis. The crescents and serum platelet count are risk predictors of poor prognosis in IgAN.