PREDICTIVE VALUE OF SMALL CRESCENTS IN IGA NEPHROPATHY - ANALYSIS OF 4 PATIENTS SHOWING A DETERIORATED RENAL-FUNCTION DURING A LONG FOLLOW-UP PERIOD

Four patients with IgA nephropathy developed a chronic renal failure d uring a long follow-up period ranging from three to 8.5 years (mean 6. 4 years). All patients showed a normal renal function, normal blood pr essure and mild proteinuria at the time of the first renal biopsy. The first biopsies showed focal mesangial proliferation with small cellul ar crescents in a small percentage of the observed glomeruli. No case showed sclerotic changes in the interstitium and vessels. In contrast, at the second biopsies, all of them exhibited a deteriorated renal fu nction, hypertension and massive proteinuria. The second biopsies reve aled marked sclerotic changes in the glomeruli, interstitium, and vess els with significant focal segmental glomerular sclerosis and adhesion s. Since no established factors predisposing the patients to chronic r enal insufficiency had been observed at the time of the first biopsy, it was suggested that small crescents, even if focal, should be regard ed as indicating an unfavorable prognosis.