IgA Nephropathy with Crescents: A Single-Center Experience.

Introduction: The presence of crescents in IgA nephropathy (IgAN) has been associated with a poor prognosis. We assess the prognosis of crescents in our patients with IgAN.

Methods: IgAN was diagnosed in 73 patients biopsied at Rush University Medical Center from 1992 to 2020, and crescents were seen in 26 (36%). Clinical, laboratory and histologic features at biopsy, and treatment and outcome (end-stage kidney disease, ESKD) were collected retrospectively. Data are presented as mean ± SD and a p value of <0.05 was significant.

Results: There was no difference in hypertension, SCr, or eGFR in patients with crescents compared to those without crescents but patients with crescents had higher UPro/Cr ratio (2.8 ± 2.7 vs. 1.7 ± 1.7 g/g, p 0.04). The percentage of glomeruli with global and segmental sclerosis (32 ± 25% vs. 38 ± 28%, p 0.35) and the proportion of interstitial fibrosis and tubular atrophy (22 ± 20% vs. 22 ± 22%, p 0.76) were similar. Only 19% of patients with crescents had lesions involving ≥25% of glomeruli. A larger proportion of patients with crescents were treated with immunosuppressive agents (70% vs. 21%, p 0.0005). After 8.4 ± 7 years of follow-up, ESKD (19% vs. 23%, p 0.77) and renal survival at 10 years (80% vs. 74%, p 0.99) were similar in patients with and without crescents.

Conclusion: The presence of crescents in IgAN was not associated with an increased risk of progression to ESKD. This may be a result of the fact that the majority of our patients had crescents involving <25% of glomeruli and received aggressive treatment with immunosuppressive agents.