Role of crescents for lupus nephritis in clinical, pathological and prognosis: a single-center retrospective cohort study

European Journal of Medical Research

Research

Bo Chen¹  Xueting Liu¹  Yan Liang¹  Ya Hu¹  Sishi Lin¹  Duo Li¹  Chaosheng Chen¹  Ji Zhang¹  Yongheng Bai² 

[1] Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, Zhejiang, People’s Republic of China;Institute of Chronic Kidney Disease, Wenzhou Medical University, 325000, Wenzhou, Zhejiang, People’s Republic of China;Institute of Chronic Kidney Disease, Wenzhou Medical University, 325000, Wenzhou, Zhejiang, People’s Republic of China;Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;

关键词: Lupus nephritis;    Crescent;    Renal pathology;    Outcome;   

DOI  :  10.1186/s40001-023-01022-9

 received in 2022-09-04, accepted in 2023-01-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundReferring to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2018 pathological classification, we aim to reveal the significance of cellular/fibrocellular crescents in lupus nephritis (LN) patients.MethodsPatients with LN proven by renal biopsy at the First Affiliated Hospital of Wenzhou Medical University from December 2001 to November 2017 were identified, and eligible cases were divided into two groups according to the presence or absence of cellular/fibrocellular crescents in renal biopsy tissues.ResultsA total of 401 LN patients were identified from our follow-up database, and 296 eligible LN patients were enrolled in the study. Of these patients, 146 patients in the group without cellular/fibrocellular crescents (non-crescent group) and 150 patients in the group with cellular/fibrocellular crescents (Crescent group). The median follow-up time of patients was 47 months, and a total of 54 patients progressed to the composite endpoint. Crescent group had higher serum creatinine, lower serum albumin, higher systemic lupus erythematosus (SLE) disease activity index, and higher activity index of renal tissue. The interaction between cellular/fibrocellular crescents and proteinuria at baseline was associated with the prognostic risk of LN (P = 0.006). In the group with proteinuria < 3.5 g/24 h, the prognosis of crescent group was significantly worse than of non-crescent group (P < 0.001), while in the group with proteinuria ≥ 3.5 g/24 h, there was no significant relationship between crescents and prognosis (p = 0.452). By multivariable Cox hazard analysis, positive anti-dsDNA, chronic index of renal biopsy tissue, cellular/fibrocellular crescents and its interaction with 24 h proteinuria were independent risk factors for poor prognosis of LN.ConclusionsLN patients with cellular/fibrocellular crescents had more severe and active disease features, and cellular/fibrocellular crescents is a risk factor for poor prognosis of LN. There was an interaction between cellular/fibrocellular crescents and proteinuria in predicting poor prognosis, and among patients with low levels of proteinuria at the time of renal biopsy, those with crescents had a worse long-term prognosis than those without crescents.

【 授权许可】

CC BY   
© The Author(s) 2023

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