Journal article
Utility of the 2018 revised ISN/RPS thresholds for glomerular crescents in childhood-onset lupus nephritis: a Pediatric Nephrology Research Consortium study
Pediatric nephrology (Berlin, West), Vol.37(12), pp.3139-3145
12/01/2022
DOI: 10.1007/s00467-022-05524-2
PMID: 35347402
Abstract
Background The revised 2018 ISN/RPS Classification System for lupus nephritis (LN) includes calculations for both activity index (A.I.) and chronicity index (C.I.). Unchanged were the thresholds of <25%, 25-50%, and > 50% crescents to distinguish between mild, moderate, and severe activity/chronicity. We aimed to evaluate these thresholds for percent crescents in childhood-onset LN.
Methods Eighty-six subjects <21 years of age were enrolled from the Pediatric Glomerulonephritis with Crescents Registry, a retrospective multi-center cohort sponsored by the Pediatric Nephrology Research Consortium. Thresholds of 10%, 25%, and 50% for both cellular/fibrocellular and fibrous crescents were interrogated for primary outcomes of kidney failure, eGFR, and eGFR slope.
Results Median age at time of initial biopsy was 14 years (range 1-21). Median follow-up time was 3 years (range 1-11). Cumulative incidence of kidney failure was 6% at 1 year and 10% at latest follow-up. Median eGFR slope was -18 mL/1.73 m(2) /min (IQR- 51 to + 8) at 1 year and - 3 mL/min/1.73 m(2)/year (IQR - 19 to + 6) at latest follow-up. We found no difference in kidney failure at the proposed <25% and 25-50% cellular crescents thresholds, and thus added a new provisional threshold of 10% that better predicted outcomes in children. Moreover, use of 10% and 25% thresholds for fibrous crescents showed a fourfold and sevenfold increase in risk of kidney failure.
Conclusions In children with crescentic LN, use of 10% and 25% thresholds for cellular crescents better reflects disease activity, while these thresholds for fibrous crescents better discriminates kidney disease outcomes.
Details
- Title: Subtitle
- Utility of the 2018 revised ISN/RPS thresholds for glomerular crescents in childhood-onset lupus nephritis: a Pediatric Nephrology Research Consortium study
- Creators
- Pooja Patel - Baylor College of MedicineMarietta de Guzman - Baylor College of MedicineM. John Hicks - Baylor College of MedicineJoseph G. Maliakkal - Saint Louis UniversityMichelle N. Rheault - University of MinnesotaDavid T. Selewski - Medical University of South CarolinaKatherine Twombley - Medical University of South CarolinaJason M. Misurac - University of IowaCheryl L. Tran - Pediatric Nephrology, Mayo Clinic, Rochester, MN, USA.Alexandru R. Constantinescu - Joe DiMaggio Children's HospitalAli M. Onder - University of MississippiMeredith Seamon - University of UtahWacharee Seeherunvong - University of MiamiVaishali Singh - Medical College of WisconsinCynthia Pan - Medical College of WisconsinDaryl M. Okamura - Seattle Children's HospitalAbiodun Omoloja - Wright State UniversityMahmoud Kallash - Nationwide Children's HospitalWilliam E. Smoyer - Nationwide Children's HospitalGuillermo Hidalgo - Hackensack Meridian HealthScott E. Wenderfer - Baylor College of Medicine
- Resource Type
- Journal article
- Publication Details
- Pediatric nephrology (Berlin, West), Vol.37(12), pp.3139-3145
- DOI
- 10.1007/s00467-022-05524-2
- PMID
- 35347402
- NLM abbreviation
- Pediatr Nephrol
- ISSN
- 0931-041X
- eISSN
- 1432-198X
- Publisher
- Springer Nature
- Number of pages
- 7
- Grant note
- Department of Pediatrics at East Carolina University Brody School of Medicine
- Language
- English
- Date published
- 12/01/2022
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9984353936702771
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