Cellular crescents and segmental glomerular necrosis in IgA nephropathy are indicative of the beneficial effects of corticosteroid therapy

Objective Recent reports have revealed that corticosteroid (PSL) therapy ha s a long-term beneficial effect for stabilization of renal function in prog ressive IgA nephropathy. Patients and methods We analyzed serum creatinine (Cr), daily proteinuria a nd the results of other routine laboratory examinations during a short-term course of PSL therapy in 28 eases of progressive IgA nephropathy. The case s were divided into two groups according to changes in renal function durin g the PSL treatment period: group I (15 cases), improved renal function; gr oup II (13 cases), no significant change in renal function. Results In group I, serum Cr and proteinuria were significantly decreased, with maximum effects observed at 3 months of PSL therapy, and remained low during the period of treatment. In contrast, group II showed no significant changes in serum Cr levels during the period of therapy, although proteinu ria was transiently decreased after 3 months of therapy. Histologically, ce llular/fibrocellular (C/F) crescents and/or segmental glomerular necrosis ( SGN) occurred with a significantly higher incidence in group I (87%) than i n group II (46%) (p<0.05). Conclusions These results suggested that the early response to PSL in reduc ing serum Cr and proteinuria by 3 months of treatment may be clinically use ful to predict the prognosis of IgA nephropathy and that C/F crescents and/ or SGN may be histologically indicative of the beneficial effects of PSL th erapy in IgA nephropathy.