CRESCENTIC IGA NEPHROPATHY: PROGNOSIS AND PREDICTORS OF OUTCOMES

Abstract

Introduction: Crescentic IgA nephropathy is associated with poor outcomes;50-90% progress to End Stage Kidney Disease (ESKD) in the short term. In the present study, we report the predictors of short-term outcomes in crescentic IgA nephropathy and tested the utility of a creatinine cutoff of 6.8 mg/dL in predicting adverse outcomes.

Methods: All cases of crescentic IgA nephropathy admitted from January 2013 to December 2023 were included. Outcomes were defined at one year as either complete recovery (eGFR >60), partial recovery (eGFR 15–60), or Major Adverse Kidney events (MAKE). MAKE was defined as the presence of any one among the following at the end of one year:  ESKD, dialysis independence with an eGFR <15 ml/min/1.73 m², death, or preemptive transplant.  

Results: Forty-nine cases were identified over 11 years, and approximately 87% received immunosuppressive therapy.  MAKE was reported in 72 % at the end of one year, with ESKD in 57.4%. Serum creatinine at the time of biopsy [OR 1.540, 95% CI 1.064, 2.229] and percentage of fibrocellular crescents [OR 1.098, 95% CI 1.006, 1.198] were predictive of MAKE at one year. A serum creatinine cut-off of 6.8 mg/dl at admission had a sensitivity of 79 % (95% CI  62,91) for MAKE and 96% (95% CI 81,100) for ESKD at one year.

Conclusions: Despite receiving immunosuppressive therapy, crescentic IgA nephropathy is associated with non-recovery in more than three-fourths of affected individuals. A serum creatinine of >6.8 mg/dl at presentation portends a poor prognosis.