Introduction: In 2016, the Oxford Classification of IgA nephropathy (IgAN) updated its scoring system for the glomerular crescents. Despite this, the clinical significance of crescentic lesions in the updated Oxford classification is still unexplored through prospective cohort studies. Methods: 134 patients diagnosed with IgAN accompanied with C2 lesions at Peking University First Hospital were consecutively enrolled and prospectively followed up for analysis. Multivariate Cox regression in combination with LASSO regression was used to analyze risk factors associated with end-stage kidney disease (ESKD). Results: During biopsy, the mean estimated glomerular filtration rate (eGFR) was 39.3 mL/min/1.73 m2, and the mean proteinuria was 4.4 g/day. The proportion of kidney failure at 1 year, 2 years, and 3 years were 24%, 34%, and 47%, respectively. The results of LASSO in combination with Cox regression showed that mean arterial pressure (hazard ratio [HR] = 1.035, 95% confidence interval [95% CI] 1.013–1.056, p = 0.001), eGFR at biopsy (HR = 0.968, 95% CI [0.948–0.990], p < 0.004) and T2 lesions (HR = 2.490, 95% CI [1.179–5.259], p = 0.017) were independent risk factor associated with ESKD in patients with C2 lesions. Furthermore, based on univariate analyses, we found that patients with kidney function declined more than 50% within 3 months prior to biopsy or pathological findings indicated a proportion of crescents exceeding 50% were both associated with a poor kidney prognosis. Lastly, when the proportion of the crescent was less than 50%, patients receiving combined steroid and immunosuppressant treatment did not exhibit a better renal prognosis than those receiving steroid only. Conclusion: Patients diagnosed with IgAN and concurrent C2 lesions exhibited a poor clinical prognosis, necessitating more effective treatment strategies.

1.
Working Group of the Internationa, l IgA Nephropathy Network and the Renal Pathology Society
;
Roberts
ISD
,
Cook
HT
,
Troyanov
S
,
Alpers
CE
,
Amore
A
, et al
.
The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility
.
Kidney Int
.
2009
;
76
(
5
):
546
56
.
2.
Working Group of the International IgA Nephropathy Network and the Renal Pathology Society
,
Cattran
DC
,
Coppo
R
,
Cook
HT
,
Feehally
J
,
Roberts
ISD
, et al
.
The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification
.
Kidney Int
.
2009
;
76
(
5
):
534
45
.
3.
Haas
M
,
Verhave
JC
,
Liu
Z-H
,
Alpers
CE
,
Barratt
J
,
Becker
JU
, et al
.
A multicenter study of the predictive value of crescents in IgA nephropathy
.
J Am Soc Nephrol
.
2017
;
28
(
2
):
691
701
.
4.
Trimarchi
H
,
Barratt
J
,
Cattran
DC
,
Cook
HT
,
Coppo
R
,
Haas
M
, et al
.
Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group
.
Kidney Int
.
2017
;
91
(
5
):
1014
21
.
5.
Coppo
R
,
Troyanov
S
,
Bellur
S
,
Cattran
D
,
Cook
HT
,
Feehally
J
, et al
.
Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments
.
Kidney Int
.
2014
;
86
(
4
):
828
36
.
6.
Katafuchi
R
,
Ninomiya
T
,
Nagata
M
,
Mitsuiki
K
,
Hirakata
H
.
Validation study of Oxford classification of IgA nephropathy: the significance of extracapillary proliferation
.
Clin J Am Soc Nephrol
.
2011
;
6
(
12
):
2806
13
.
7.
Zeng
C-H
,
Le
W
,
Ni
Z
,
Zhang
M
,
Miao
L
,
Luo
P
, et al
.
A multicenter application and evaluation of the Oxford classification of IgA nephropathy in adult Chinese patients
.
Am J Kidney Dis
.
2012
;
60
(
5
):
812
20
.
8.
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group
.
KDIGO clinical practice guideline for glomerulonephritis
.
Kidney Int Suppl
.
2012
;
2
(
2
):
139
274
.
9.
Kidney Disease Improving Global Outcomes KDIGO Glomerular Diseases Work Group
,
Adler
SG
,
Barratt
J
,
Bridoux
F
,
Burdge
KA
,
Chan
TM
.
KDIGO 2021 clinical practice guideline for the management of glomerular diseases
.
Kidney Int
.
2021
;
100
(
4S
):
S1
276
.
10.
Kellum
JA
,
Lameire
N
,
Aspelin
P
,
Barsoum
RS
,
Burdmann
EA
,
Goldstein
SL
, et al
.
Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury
.
Kidney Int supplements
.
2012
;
2
(
1
):
1
138
.
11.
Moreno
JA
,
Martín-Cleary
C
,
Gutiérrez
E
,
Toldos
O
,
Blanco-Colio
LM
,
Praga
M
, et al
.
AKI associated with macroscopic glomerular hematuria: clinical and pathophysiologic consequences
.
Clin J Am Soc Nephrol
.
2012
;
7
(
1
):
175
84
.
12.
Lv
J
,
Yang
Y
,
Zhang
H
,
Chen
W
,
Pan
X
,
Guo
Z
, et al
.
Prediction of outcomes in crescentic IgA nephropathy in a multicenter cohort study
.
J Am Soc Nephrol
.
2013
;
24
(
12
):
2118
25
.
13.
Yu
G
,
Zhang
Y
,
Meng
B
,
Xie
X
,
Wang
Z
,
Ying
W
, et al
.
O-glycoforms of polymeric immunoglobulin A1 in the plasma of patients with IgA nephropathy are associated with pathological phenotypes
.
Nephrol Dial Transplant
.
2021
;
37
(
1
):
33
41
.
14.
Wang
Z
,
Xie
X
,
Li
J
,
Zhang
X
,
He
J
,
Wang
M
, et al
.
Complement activation is associated with crescents in IgA nephropathy
.
Front Immunol
.
2021
;
12
:
676919
.
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