Clinicopathological and long-term prognostic features of membranous nephropathy with crescents: a Japanese single-center experience

  • Masaya Saito
  • Atsushi Komatsuda
  • Ryuta Sato
  • Ayano Saito
  • Hajime Kaga
  • Fumito Abe
  • Masato Sawamura
  • Mizuho Nara
  • Masaru Togashi
  • Shin Okuyama
  • Hideki Wakui
  • Naoto Takahashi
Original article

Abstract

Background

Three recent studies from the United States and China reported the clinicopathological features and short-term prognosis in patients with membranous nephropathy (MN) and crescents in the absence of secondary MN, anti-glomerular basement membrane (GBM) antibodies, and anti-neutrophil cytoplasmic antibodies (ANCA).

Methods

We compared clinicopathological and prognostic features in 16 MN patients with crescents (crescent group) and 38 MN patients without crescents (control group), in the absence of secondary MN, anti-GBM antibodies, and ANCA. Median follow-up periods in the crescent and control groups were 79 and 50 months, respectively.

Results

Decreased estimated glomerular filtration rates (<50 mL/min/1.73 m2), glomerulosclerosis, and moderate-to-severe interstitial fibrosis were more frequently observed in the crescent group than in the control group (P = 0.043, P = 0.004, and P = 0.035, respectively). Positive staining rates for glomerular IgG2 and IgG4 were significantly different between the 2 groups (P = 0.032, P = 0.006, respectively). Doubling of serum creatinine during follow-up was more frequently observed in the crescent group than in the control group (P = 0.002), although approximately two-thirds of patients in the crescent group were treated with immunosuppressive therapy. Crescent formation and interstitial fibrosis were risks for doubling of serum creatinine [hazard ratio (HR) = 10.506, P = 0.012; HR = 1.140, P = 0.009, respectively].

Conclusions

This is the first Japanese study demonstrating significant differences in clinicopathological and prognostic features between the 2 groups. Most patients in the crescent group may develop a long-term decline in renal function despite immunosuppressive therapy.

Keywords

Clinicopathological study Crescent formation IgG-subclass Membranous nephropathy Prognosis 

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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Masaya Saito
    • 1
  • Atsushi Komatsuda
    • 1
  • Ryuta Sato
    • 1
  • Ayano Saito
    • 1
  • Hajime Kaga
    • 1
  • Fumito Abe
    • 1
  • Masato Sawamura
    • 1
  • Mizuho Nara
    • 1
  • Masaru Togashi
    • 1
  • Shin Okuyama
    • 1
  • Hideki Wakui
    • 2
  • Naoto Takahashi
    • 1
  1. 1.Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
  2. 2.Department of Life ScienceAkita University Graduate School of Engineering ScienceAkitaJapan

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