Prediction of renal outcomes in patients with crescentic lupus nephritis

Few studies are currently available about the renal survival and risk factors of crescentic lupus nephritis (cLN). We retrospectively analyzed data from Chinese patients with cLN in our center to identify the prognostic factors.

One hundred twenty-four cases of biopsy-proven LN with ≥50% crescents (cLN) were included in this study. Another 100 patients with LN without crescents were randomly enrolled as a control group. Their clinicopathological data and long-term outcome were compared.

There were 101 females and 23 males with an average age of 32.0 ± 13.5 years followed for a median period of 4 years. At biopsy, the mean SCr level was 2.4 ± 2.0 mg/dL, and the mean percentage of crescents was 64.4 ± 13.3%. The renal survival rates at years 1, 3 and 5 after biopsy of cLN group and the control group were 82.3% versus 97.8%, 78.4% versus 92.6% and 70.2% versus 84.9%, respectively. Multivariate Cox regression revealed initial SCr concentration as the only independent risk factor for end-stage renal disease (hazard ratio: 1.433, P < 0.001). Logistic regression showed that the risk of end-stage renal disease at 5 years after biopsy increased rapidly at SCr >1.4 mg/dL and reached 90% at SCr >5.5 mg/dL.

Crescentic LN had worse treatment response and lower probability of renal survival than those without crescents. Initial SCr concentration may predict kidney failure in patients with crescentic disease.