Abstract
Objective This study analyzed the associations of different crescents’ fraction and clinical features in a Chinese lupus nephritis cohort based on the 2018 revision of ISN/RPS classification system. Methods A total of 288 lupus nephritis patients with complete clinicopathological data and well follow-up was enrolled. The fraction of glomeruli with cellular or fibrocellular crescents based on the new system was reevaluated. The association between crescents fractions and the outcomes were further analyzed. Results The median follow-up period was 76.5 months. Cellular or fibrocellular crescents were present in 146 (50.7%) of the total individuals. The percentage of crescents were significantly associated with severe clinical renal injury indices and other renal pathological parameter. According to the survival receiver operating characteristic (survival ROC) curve, the optimal cutoff level of cellular or fibrocellular crescents for predicting the composite events was 7.39%. By multivariable Cox hazard analysis, the presence of crescents was predictive of survival from the composite events with a hazard ratio [HR] of 2.5 (95% CI 1.190–5.431; p = .02). Furthermore, when we used absent, present in less than 7.39% of glomeruli, and present in greater than or equal to 7.39% of glomeruli as cutoffs in all the patients, a gradation appeared, with adjusted HRs of 2.9 (95% CI 1.326–6.313; p = .008) for crescents in greater than or equal to 7.39% of glomeruli, in reference to no crescents. Conclusion We proposed that the crescents were not uncommon and had important clinical significance in lupus nephritis. The cutoff point of crescents as prognosticator might be nearly 7.39%.
Highlights
Renal involvement is common in systemic lupus erythematosus (SLE) and the pathological phenotypes of lupus nephritis varied a lot
Our previous study suggested that the patients with “true” crescentic glomerulonephritis presented with more severe outcomes in lupus nephritis [3], which was consistent with other reports
It was showed that the cutoff level of cellular or fibrocellular crescents for predicting the composite events was 7.39%, which was fully data driven in our study
Summary
Renal involvement is common in systemic lupus erythematosus (SLE) and the pathological phenotypes of lupus nephritis varied a lot. Proliferation, a key feature of active lupus nephritis, includes endocapillary hypercellularity and extracapillary hypercellularity (crescents). Crescents are fairly not uncommon in biopsy samples from lupus nephritis patients [1,2]. Our previous study suggested that the patients with “true” crescentic glomerulonephritis presented with more severe outcomes in lupus nephritis [3], which was consistent with other reports [1,4,5], the effect of different fractions of crescents was not determined yet. A 2018 revision of the International Society of Nephrology/Renal Pathology Society (ISN/RPS) lupus nephritis classification system has been established recently, in which more clear definitions are provided for cellular, fibrocellular and fibrous crescents [6]. The pathological active (cellular or fibrocellular) crescents were reevaluated, and their clinical significances were further analyzed in a large well-defined lupus nephritis cohort based on the 2018 system
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