Fanghao Cai1,2, Fei Han3,4, Hongya Wang1,2, Haidongqin Han1,2, Jingyun Le1,2, Lan Lan1,2, Ying Xu1,2, Jianghua Chen1,2. 1. From the Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, China. 2. F. Cai, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; F. Han, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; H. Wang, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; H. Han, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; J. Le, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology; L. Lan, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; Y. Xu, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; J. Chen, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine. 3. From the Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, China. hanf8876@zju.edu.cn. 4. F. Cai, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; F. Han, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; H. Wang, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; H. Han, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University; J. Le, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology; L. Lan, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; Y. Xu, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine; J. Chen, MD, Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, and the Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine. hanf8876@zju.edu.cn.
Abstract
OBJECTIVE: To determine the association between crescents and renal outcomes, and the implications on therapeutic choices. METHODS: There were 231 patients with biopsy-proven proliferative lupus nephritis (PLN) who were divided into 4 groups: 59 patients were in the noncrescent group (NC); 59 patients exclusively with segmental crescents were in the segmental crescent group (SC); patients with circumferential crescents were categorized into 2 groups according to the crescentic ratio (C1 had 64 patients with ≤ 25%, and C2 had 49 patients with > 25%). Their baseline laboratory tests, histopathological manifestations, and outcomes were compared. RESULTS: Remission rates in NC, SC, C1, and C2 groups were 92.1%, 85.4%, 95.0%, and 76.1%, respectively. Fewer patients in the C2 group achieved complete remission than the other 3 groups. For longterm outcomes evaluated by serum creatinine (SCr) doubling or endstage renal disease (ESRD), the renal survival rate was lowest in the C2 group (p = 0.003). Including clinical and pathological variables in the Cox proportional hazard regression model separately, the multivariate analysis revealed that these were independent risk factors for SCr doubling or ESRD: baseline SCr (with every 1 mg/dl increase: HR = 1.834, 95% CI 1.465-2.296; p < 0.001), hemoglobin (with every 1 g/l increase: HR = 0.970, 95% CI 0.947-0.992; p = 0.009), the proportions of cellular crescents (with every 1% increase: HR = 1.040, 95% CI 1.015-1.066; p = 0.002) and fibrocellular crescents (with every 1% increase: HR = 1.085, 95% CI 1.013-1.163; p = 0.020), and severe renal tubular atrophy (HR = 5.348, 95% CI 1.278-22.373; p = 0.022). CONCLUSION: PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.
OBJECTIVE: To determine the association between crescents and renal outcomes, and the implications on therapeutic choices. METHODS: There were 231 patients with biopsy-proven proliferative lupus nephritis (PLN) who were divided into 4 groups: 59 patients were in the noncrescent group (NC); 59 patients exclusively with segmental crescents were in the segmental crescent group (SC); patients with circumferential crescents were categorized into 2 groups according to the crescentic ratio (C1 had 64 patients with ≤ 25%, and C2 had 49 patients with > 25%). Their baseline laboratory tests, histopathological manifestations, and outcomes were compared. RESULTS: Remission rates in NC, SC, C1, and C2 groups were 92.1%, 85.4%, 95.0%, and 76.1%, respectively. Fewer patients in the C2 group achieved complete remission than the other 3 groups. For longterm outcomes evaluated by serum creatinine (SCr) doubling or endstage renal disease (ESRD), the renal survival rate was lowest in the C2 group (p = 0.003). Including clinical and pathological variables in the Cox proportional hazard regression model separately, the multivariate analysis revealed that these were independent risk factors for SCr doubling or ESRD: baseline SCr (with every 1 mg/dl increase: HR = 1.834, 95% CI 1.465-2.296; p < 0.001), hemoglobin (with every 1 g/l increase: HR = 0.970, 95% CI 0.947-0.992; p = 0.009), the proportions of cellular crescents (with every 1% increase: HR = 1.040, 95% CI 1.015-1.066; p = 0.002) and fibrocellular crescents (with every 1% increase: HR = 1.085, 95% CI 1.013-1.163; p = 0.020), and severe renal tubular atrophy (HR = 5.348, 95% CI 1.278-22.373; p = 0.022). CONCLUSION: PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.
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