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- Title
Crescents, an Independent Risk Factor for the Progression of Type 2 Diabetic Kidney Disease.
- Authors
Liya Sun; Tongyue Duan; Qing Zhao; Lujun Xu; Yachun Han; Yiyun Xi; Xuejing Zhu; Liyu He; Chengyuan Tang; Xiao Fu; Lin Sun
- Abstract
Context: Crescents have been noticed in pathologic changes in patients with diabetic kidney disease (DKD). However, the clinical significance of crescents is still not well recognized. Objective: The main objective was to investigate the association between crescents and the prognoses of type 2 DKD (T2DKD) patients, and, secondly, to analyze the relationship between crescents and clinicopathologic features. Methods: A retrospective cohort study of 155 patients with T2DKD diagnosed by renal biopsy was carried out in a single center. Clinicopathologic features of patients with or without crescents were analyzed. Cox regression models and meta-analysis were used to determine the prognostic values of crescents for T2DKD. A nomogram was constructed to provide a simple estimation method of 1, 3, and 5-year renal survival for patients with T2DKD. Results: Compared with T2DKD patients without crescents, patients with crescents had higher 24-hour proteinuria and serum creatinine levels, as well as more severe Kimmelstiel-Wilson (K-W) nodules, segmental sclerosis (SS), and mesangiolysis (all P < .05). Furthermore, the crescents were positively correlated with serum creatinine, 24-hour proteinuria, K-W nodules, SS, mesangiolysis, and complement 3 deposition. Multivariate Cox models showed that crescents were an independent prognostic risk factor for renal survival (hazard ratio [HR] 2.68, 95% CI 1.27-5.64). The meta-analyzed results of 4 studies on crescents in T2DKD confirmed that patients with crescents had a significantly higher HR for renal progression. Conclusion: Patients with crescents in T2DKD have more severe clinicopathologic changes and worse prognoses. The crescent can serve as an independent risk factor for T2DKD progression.
- Subjects
CRESCENTS (Shapes); DIABETIC nephropathies; RENAL biopsy; CREATININE; PROTEINURIA
- Publication
Journal of Clinical Endocrinology & Metabolism, 2022, Vol 107, Issue 10, p2758
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgac416