Clinical Significance of C2 Lesions in IgAN

The 2016 Oxford Classification of IgA Nephropathy (IgAN) included an updated scoring system for glomerular crescents. However, prospective cohort studies have not examined the clinical significance of crescentic lesions.

To help address this gap, Zi Wang, MD, and colleagues enrolled 134 Peking University First Hospital patients with IgAN and C2 lesions in a prospective study. The researchers utilized multivariate Cox regression and LASSO regression to analyze risk factors associated with end-stage renal disease. Their findings appeared in the American Journal of Nephrology.

The average mean eGFR at biopsy was 39.3 mL/min/1.73 m² and the average mean proteinuria was 4.4 g/day. At 1 year, 2 years, and 3 years of follow-up, 24%, 34%, and 47% of study participants had kidney failure, respectively.

LASSO and Cox regression analyses found that eGFR at biopsy (HR=0.968; 95% CI, 0.948-0.990; P<.004), mean arterial pressure (HR=1.035; 95% CI, 1.013-1.056; P=.001), and T2 lesions (HR=2.490; 95% CI, 1.179-5.259; P=.017) were independent risk factors associated with ESRD among patients with C2 lesions.

Univariate analysis showed that kidney function decline of more than 50% within three months prior to biopsy and pathological findings indicating a proportion of crescents exceeding 50% were associated with poor kidney prognosis. When the proportion of the crescents were less than 50%, patients receiving a combination of steroid and immunosuppressant treatment did not demonstrate an improved renal prognosis compared to patients receiving only steroids.

In summary, the authors found that patients diagnosed with IgAN and C2 lesions displayed a poor clinical prognosis requiring more effective treatment strategies.

Source: American Journal of Nephrology