The management of Immunoglobulin A nephropathy (IgAN) entails a prolonged and recurring process. Patients with IgAN often undergo repeated episodes of disease activation, posing a great challenge for the long-term management.
In real-world clinical practice, clinicians often face the task of evaluating diverse clinical factors and making prompt judgments about kidney biopsies. Nevertheless, this decision-making process can occasionally be subjective, given the limited evidence supporting the necessity of biopsies. To address this, we developed this user-friendly online tool, Crescent Calculator. The purpose of this tool is to predict the likelihood of crescent lesions in individuals with IgAN by incorporating a range of clinical variables. Through this approach, the Crescent Calculator empowers medical professionals to make timely, objective, and well-informed decisions concerning the necessity of biopsies and the appropriate use of immunosuppressive therapy for patients with IgAN.
The model was constructed based on 1,412 IgAN patients from Zhejiang province, China. The performance has been validated by two independent cohorts. The AUCs ranged from 0.82 to 0.85 based on the external testing datasets. In addition, to cater to different clinical needs, we have established various thresholds for the crescent and non-crescent classification.
By default, we used the threshold at the risk score > 0.277, resulting in 82.5% sensitivity and 77.3% specificity for the classification. However, if you want to maximize the identification of crescent lesions for patients who need to be further confirmed by kidney biopsy, the threshold could be adjusted at the risk score > -0.130, which supposedly achieves 90.0% sensitivity and 61.0% specificity. If you want to identify patients who are most likely affect by the crescent lesions, the threshold could be further adjusted at the risk score > 1.057, which theoretically achieves 90.0% specificity and 56.2% sensitivity.
More information can be found at our publication "Crescent Calculator : A Webtool Enabling Objective Decision-Making for Assessment of IgA Nephropathy Immune Activity Throughout the Disease Course".
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Age: age at diagnosis BMI: body mass index SBP: systolic blood pressure TC: total cholesterol IgA1: immunoglobulin A1 |
eGFR: estimated glomerular filtration rate C4: complement uPCR: Urine protein creatinine ratio uRBCs: Urinary red ball cells |