| Clinicopathologic Characteristics of IgA Nephropathy with Crescents |
| Yanggyun Kim, M.D., Taewon Lee, M.D., Sangho Lee, M.D., Kyunghwan Jeong, M.D., Juyoung Moon, M.D. and Chungyoo Ihm, M.D. |
| Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea |
| 원저 : 반월상을 보이는 면역글로불린 A 신증 환자들의 임상-병리학적 특성 |
| 김양균, 이태원, 이상호, 정경환, 문주영, 임천규 |
| 경희대학교 의학전문대학원 신장내과학교실 |
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| Abstract |
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Purpose: In IgA nephropathy (IgAN), crescent formation appears to represent a nonspecific response to severe injury to the glomerular capillary wall. This study was performed to evaluate the clinicopathological manifestations of the crescents and their effects on the clinical courses of IgAN. Methods: The patients diagnosed IgAN were included and the information about their renal biopsies, chemistries and immunohistochemistry findings were collected retrospectively. Some patients that have similar renal function and protenuria were followed up for 12 months to examine the effects of crescents on the renal prognosis.
Results: 38 patients with crescents and 177 patients without crescents were enrolled. The patients with IgAN with crescents showed significantly lower renal function (MDRD eGFR 58.5 vs 88.4 ml/min/1.73 m2), higher blood pressure, larger amount of proteinuria and more severe hematuria than those patients without crescents. In pathologic findings, HS Lee grades were higher (2.9 vs 1.9). When we selected patients with mildly decreased renal function (serum creatinine <2.5 mg/dL, PCR 0.5-8 g/gCr), the patients with crescents presented lower renal function and higher proteinuria but no statistical significance. After 12 months of treatment, the patients with crescents showed significantly lower renal function (MDRD eGFR 78.6 vs 96.5 ml/min/1.73m2) and higher proteinuria (0.9 vs 0.6 g/gCr).
Conclusion: The patients with IgAN with crescents showed more deteriorated clinicopathological findings than those without crescents. Despite aggressive treatments, they presented a significantly decreased renal function and larger amount of proteinuria after 1 year. So crescents are supposed to have poor effects on the clinical course. |
| Key Words:
IgA nephropathy, Crescent, Proteinuria, Renal function |
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