Skip to main content

Advertisement

SpringerLink
Log in

Crescent lesions are not a predictive factor in adult-onset Henoch–Schönlein purpura nephritis

  • Original Article
  • Published:
Clinical and Experimental Medicine Aims and scope Submit manuscript

Abstract

Henoch–Schönlein purpura nephritis (HSPN) is a common secondary glomerulonephritis, and its prognosis mainly depends on the severity of renal impairment. To date, the significance of crescent lesions in adult-onset HSPN is still unclear. Therefore, the purpose of this research was to assess whether crescents could predict the renal outcomes in adult HSPN patients. A total of 188 adult patients with HSPN proven by renal biopsy were enrolled in this prospective study. Patients were divided into three groups based on the proportion of crescents: non-crescent group (C0, n = 110), crescent ≤ 25% group (C1, n = 50) and crescent > 25% group (C2, n = 28). The composited endpoint was defined as eGFR decreased > 50% of baseline level, reached end-stage renal disease and/or death. Among three groups, clinical pathological features, treatment regimens and renal outcomes were compared. During a mean follow-up of 26 months, 78 (42.5%) patients had crescent lesions. A total of ten (9.1%) patients in C0 group and five (17.9%) patients in C2 group reached the combined endpoint, but no patients in C1 group reached endpoint. Renal survival analysis indicated patients in C1 group tended to have the best renal outcome, while patients in C2 group had the poorest renal survival. Moreover, Cox regression analysis revealed crescents were not a predictor of poor developing to renal outcome after adjusting potential confounders [hazard ratio (HR) = 0.28, 95% confidence interval (CI) 0.07–1.18, P = 0.083]. Crescent formation is not necessarily a predictive factor of poor renal survival in adult HSPN patients who had small proportions of crescents (crescent ≤ 25%).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McCarthy HJ, Tizard EJ. Clinical practice: diagnosis and management of Henoch–Schonlein purpura. Eur J Pediatr. 2010;169(6):643–50.

    Article  Google Scholar 

  2. Delbet JD, Hogan J, Aoun B, et al. Clinical outcomes in children with Henoch–Schonlein purpura nephritis without crescents. Pediatr Nephrol (Berlin, Germany). 2017;32(7):1193–9.

    Article  Google Scholar 

  3. Davin JC. Henoch–Schonlein purpura nephritis: pathophysiology, treatment, and future strategy. Clin J Am Soc Nephrol CJASN. 2011;6(3):679–89.

    Article  Google Scholar 

  4. Ronkainen J, Ala-Houhala M, Huttunen NP, et al. Outcome of Henoch–Schoenlein nephritis with nephrotic-range proteinuria. Clin Nephrol. 2003;60(2):80–4.

    Article  CAS  Google Scholar 

  5. Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood Henoch–Schonlein purpura: a retrospective cohort study. Lancet (London, England). 2002;360(9334):666–70.

    Article  Google Scholar 

  6. Shrestha S, Sumingan N, Tan J, Alhous H, et al. Henoch Schonlein purpura with nephritis in adults: adverse prognostic indicators in a UK population. QJM Mon J Assoc Physicians. 2006;99(4):253–65.

    Article  CAS  Google Scholar 

  7. Wang J, Zhu P, Cui Z, et al. Clinical features and outcomes in patients with membranous nephropathy and crescent formation. Medicine. 2015;94(50):2294.

    Article  Google Scholar 

  8. Roberts IS, Cook HT, Troyanov S, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009;76(5):546–56.

    Article  Google Scholar 

  9. Kim CH, Lim BJ, Bae YS, et al. Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch–Schonlein purpura nephritis in adults. Mod Pathol. 2014;27(7):972–82.

    Article  CAS  Google Scholar 

  10. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.

    Article  Google Scholar 

  11. Zhang W, Zhou Q, Hong L, et al. Clinical outcomes of IgA nephropathy patients with different proportions of crescents. Medicine. 2017;96(11):e6190.

    Article  Google Scholar 

  12. Kusano T, Takano H, Kang D, et al. Endothelial cell injury in acute and chronic glomerular lesions in patients with IgA nephropathy. Hum Pathol. 2016;49:135–44.

    Article  CAS  Google Scholar 

  13. Shao X, Li B, Cao L, et al. Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta-analysis. Oncotarget. 2017;8(28):46436–48.

    Article  Google Scholar 

  14. Rafieian-Kopaei M, Baradaran A, Nasri H. Significance of extracapillary proliferation in IgA-nephropathy patients with regard to clinical and histopathological variables. Hippokratia. 2013;17(3):258–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Bitencourt-Dias C, Bahiense-Oliveira M, Saldanha LB, et al. Comparative study of IgA nephropathy with and without crescents. Brazilian J Med Biol Res. 2004;37(9):1373–7.

    Article  CAS  Google Scholar 

  16. Huang X, Wu X, Le W, et al. Renal prognosis and related risk factors for Henoch–Schonlein purpura nephritis: a Chinese adult patient cohort. Sci Rep. 2018;8(1):5585.

    Article  Google Scholar 

  17. Tumlin JA, Lohavichan V, Hennigar R. Crescentic, proliferative IgA nephropathy: clinical and histological response to methylprednisolone and intravenous cyclophosphamide. Nephrol Dial Transpl. 2003;18(7):1321–9.

    Article  CAS  Google Scholar 

  18. Schena FP, Manno C. Intensive supportive care plus immunosuppression in IgA nephropathy. New Engl J Med. 2016;374(10):992.

    PubMed  Google Scholar 

  19. Shen XH, Liang SS, Chen HM, et al. Reversal of active glomerular lesions after immunosuppressive therapy in patients with IgA nephropathy: a repeat-biopsy based observation. J Nephrol. 2015;28(4):441–9.

    Article  CAS  Google Scholar 

  20. Miller MN, Baumal R, Poucell S, et al. Incidence and prognostic importance of glomerular crescents in renal diseases of childhood. Am J Nephrol. 1984;4(4):244–7.

    Article  CAS  Google Scholar 

  21. Lee MJ, Kim SJ, Oh HJ, et al. Clinical implication of crescentic lesions in immunoglobulin A nephropathy. Nephrol Dial Transpl. 2014;29(2):356–64.

    Article  CAS  Google Scholar 

  22. Haas M, Verhave JC, Liu ZH, et al. A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol JASN. 2017;28(2):691–701.

    Article  CAS  Google Scholar 

  23. Zhang X, Shi S, Ouyang Y, et al. A validation study of crescents in predicting ESRD in patients with IgA nephropathy. J Transl Med. 2018;16(1):115.

    Article  CAS  Google Scholar 

  24. Rianthavorn P, Chacranon M. Long-term renal outcome in pediatric glomerulonephritis associated with crescent formation. Clin Exp Nephrol. 2018;22(3):661–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, West China Hosiptal, Sichuan University, Chengdu, Sichuan, China

    Zheng-Xia Zhong, Jia-Xing Tan, Yi Tang, Li Tan, Gai-Qin Pei & Wei Qin

  2. Division of Nephrology, Department of Medicine, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China

    Zheng-Xia Zhong

  3. West China School of Medicine, Sichuan University, Chengdu, Sichuan, China

    Jia-Xing Tan, Li Tan & Gai-Qin Pei

Authors
  1. Zheng-Xia Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia-Xing Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gai-Qin Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Qin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of West China Hospital of Sichuan University and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhong, ZX., Tan, JX., Tang, Y. et al. Crescent lesions are not a predictive factor in adult-onset Henoch–Schönlein purpura nephritis. Clin Exp Med 19, 449–456 (2019). https://doi.org/10.1007/s10238-019-00567-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10238-019-00567-6

Keywords

Search

Navigation