Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Schreiber, J.
The prognostic value of crescents in IgA nephropathy - an observational study.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 81
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Langner Cord
- Pollheimer Marion
- Altmetrics:
- Abstract:
- Introduction: Immunoglobulin A Nephropathy (IgAN) is the most common glomerular kidney disease in the world. The overall population incidence of IgAN is approximately 2.5/100000/year and in about 20-40% of the cases IgAN is reported to progress to end-stage kidney disease (ESKD) within 10 to 20 years from onset. IgAN shows highly variable and heterogeneous clinical symptoms as well as diverse rates of frequency in different continents. In kidney biopsies, five distinct features prognostic of disease progression and outcome, have been summarized as the modified Oxford Classification. These features are mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and glomerular crescent formation (C). Aim of this study was to validate the prognostic value of the histopathological features with special emphasis on crescentic lesions on renal survival. Material and Methods: For this retrospective analysis data from 205 IgAN patients from Southeast Austria between 2002 and 2018 were collected and statistically analyzed. We performed cross tabulation, chi-squared tests and binary logistic regression analyses to determine the association between histopathological parameters and renal survival/function. Renal survival curves with the Kaplan-Meier method were generated and between-group survival was compared by using the log-rank test. The study endpoints are the onset of ESKD and/or 50% decline in estimated glomerular filtration rate (eGFR). Results: Patients with tubular atrophy/interstitial fibrosis in >25% of cortical area showed a significantly adverse renal outcome concerning the combined event (p-value<0.001). Crescentic lesions did not prove to be a significant prognostic factor for renal failure and for 50% decline of renal function. When adjusted for immunosuppressive therapy however, crescentic lesions in <25% of glomeruli were predictive of renal failure (p-value=0.001). IgAN patients with C1 lesions more likely received immunosuppressive (p-value<0.001) and antihypertensive (p-value=0.039) treatment. Fibrocellular (mixed) and fibrous (old) crescents, proved to have a significantly adverse impact on renal failure than cellular (fresh) crescents (p-value=0.002). Discussion: We could validate the prognostic value of T lesions on renal survival as the most consistent marker. Crescentic lesions however, only were predictive of renal failure once adjusted for immunosuppression. Further representative studies need to be conducted to validate the independent prognostic value of crescentic lesions.