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Crescents and IgA Nephropathy: A Delicate Marriage
IgA nephropathy (IgAN) is a progressive disease with great variability in the clinical course. Among the clinical and pathologic features contributing to variable outcomes, the presence of crescents has attracted particular interest as a distinct pathological feature associated with severity. Severa...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267724/ https://www.ncbi.nlm.nih.gov/pubmed/35806856 http://dx.doi.org/10.3390/jcm11133569 |
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author | Trimarchi, Hernán Haas, Mark Coppo, Rosanna |
author_facet | Trimarchi, Hernán Haas, Mark Coppo, Rosanna |
author_sort | Trimarchi, Hernán |
collection | PubMed |
description | IgA nephropathy (IgAN) is a progressive disease with great variability in the clinical course. Among the clinical and pathologic features contributing to variable outcomes, the presence of crescents has attracted particular interest as a distinct pathological feature associated with severity. Several uncontrolled observations have led to the general thought that the presence and extent of crescents was a prognostic indicator associated with poor outcomes. However, KDIGO 2021 guidelines concluded that either the presence or the relative number of crescents should not be used to determine the progression of IgAN nor should they suggest the choice of immunosuppression. Our aim is to report and discuss recent data on the debated issue of the value of active (cellular and fibrocellular) crescents in the pathogenesis and clinical progression of IgAN, their predictive value, and the impact of immunosuppression on renal function. We conclude that the value of crescents should not be disregarded, although this feature does not have an independent predictive value for progression in IgAN, particularly when considering immunosuppressed patients. An integrated overall evaluation of crescents with other active MEST scores, clinical data, and novel biomarkers must be considered in achieving a personalized therapeutic approach to IgAN patients. |
format | Online Article Text |
id | pubmed-9267724 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-92677242022-07-09 Crescents and IgA Nephropathy: A Delicate Marriage Trimarchi, Hernán Haas, Mark Coppo, Rosanna J Clin Med Review IgA nephropathy (IgAN) is a progressive disease with great variability in the clinical course. Among the clinical and pathologic features contributing to variable outcomes, the presence of crescents has attracted particular interest as a distinct pathological feature associated with severity. Several uncontrolled observations have led to the general thought that the presence and extent of crescents was a prognostic indicator associated with poor outcomes. However, KDIGO 2021 guidelines concluded that either the presence or the relative number of crescents should not be used to determine the progression of IgAN nor should they suggest the choice of immunosuppression. Our aim is to report and discuss recent data on the debated issue of the value of active (cellular and fibrocellular) crescents in the pathogenesis and clinical progression of IgAN, their predictive value, and the impact of immunosuppression on renal function. We conclude that the value of crescents should not be disregarded, although this feature does not have an independent predictive value for progression in IgAN, particularly when considering immunosuppressed patients. An integrated overall evaluation of crescents with other active MEST scores, clinical data, and novel biomarkers must be considered in achieving a personalized therapeutic approach to IgAN patients. MDPI 2022-06-21 /pmc/articles/PMC9267724/ /pubmed/35806856 http://dx.doi.org/10.3390/jcm11133569 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Trimarchi, Hernán Haas, Mark Coppo, Rosanna Crescents and IgA Nephropathy: A Delicate Marriage |
title | Crescents and IgA Nephropathy: A Delicate Marriage |
title_full | Crescents and IgA Nephropathy: A Delicate Marriage |
title_fullStr | Crescents and IgA Nephropathy: A Delicate Marriage |
title_full_unstemmed | Crescents and IgA Nephropathy: A Delicate Marriage |
title_short | Crescents and IgA Nephropathy: A Delicate Marriage |
title_sort | crescents and iga nephropathy: a delicate marriage |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267724/ https://www.ncbi.nlm.nih.gov/pubmed/35806856 http://dx.doi.org/10.3390/jcm11133569 |
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