Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta-analysis

Xue Shao, Bingjue Li, Luxi Cao, Ludan Liang, Jingjuan Yang, Yucheng Wang, Shi Feng, Cuili Wang, Chunhua Weng, Xiujin Shen, Hong Jiang and Jianghua Chen _

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Oncotarget. 2017; 8:46436-46448. https://doi.org/10.18632/oncotarget.17502

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Xue Shao1,2,3, Bingjue Li1,2,3, Luxi Cao1,2,3, Ludan Liang1,2,3, Jingjuan Yang1,2,3, Yucheng Wang1,2,3, Shi Feng1,2,3, Cuili Wang1,2,3, Chunhua Weng1,2,3, Xiujin Shen1,2,3, Hong Jiang1,2,3 and Jianghua Chen1,2,3

1Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

2Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China

3Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, China

Correspondence to:

Jianghua Chen, email: [email protected]

Hong Jiang, email: [email protected]

Keywords: Immunoglobulin A (IgA) nephropathy, Oxford classification, crescent lesions, meta-analysis

Received: September 26, 2016    Accepted: April 07, 2017    Published: April 28, 2017


The 2009 Oxford Classification of immunoglobulin A (IgA) nephropathy (IgAN) identifies four histological features as predictors of renal prognosis: mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T). However, the clinical and prognostic significance of crescent formation still remains controversial. Therefore, we performed a meta-analysis to evaluate the association between crescents and kidney outcome in IgAN. A total of 20 studies published from January 2009 to July 2016 involving 5,285 patients were included after systematic searches of PubMed and EMBASE databases. Pooled results showed that crescent lesions were associated with kidney failure (HR, 1.93; 95% CI, 1.49-2.50; P < 0.001). IgAN patients with crescents had lower eGFR levels (SMD, -0.21; 95% CI, -0.40--0.03; P = 0.023); higher proteinuria levels (SMD, 0.87; 95% CI, 0.11-1.63; P = 0.024); a larger number of patients with M1 (RR, 1.22; 95% CI, 1.07-1.40; P = 0.003), E1 (RR, 4.83; 95% CI, 3.04-7.66;P < 0.001), S1 (RR, 1.76; 95% CI, 1.11-2.80; P = 0.016) and T1/2 (RR, 2.74; 95% CI, 2.10-3.57; P < 0.001) lesions; and received immunosuppressive therapy more frequently (RD, 0.17; 95% CI, 0.11-0.23; P < 0.001). Our results suggest that crescent formation represents an efficient prognostic factor associated with progression to kidney failure and thus could be considered into the new Oxford Classification.

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