Clinicopathological Characteristics and Outcomes of Patients with Crescentic Lupus Nephritis

Crescentic lupus nephritis (cLN) is an uncommon and severe phenotype in LN with limited data on outcomes and relevant risk factors.

Eighty-three cases of biopsy-proven LN with ≥50% crescents were included. Another 83 non-crescentic LN patients with <50% crescents (non-cLN) were matched through propensity score as the control group.

The cLN patients accounted for 4.03% of LN patients in renal biopsy. Compared with age- and gender-matched non-cLN patients, cLN patients had higher serum creatinine levels, anti-neutrophil cytoplasmic antibody (ANCA) positivity rates, activity index, and chronic index scores, while the positive rate of anti-dsDNA antibodies and complement 3 were lower. The cLN patients exhibited a lower treatment response rate than matched non-cLN patients (34.8% vs. 64.3%, p < 0.001). The median follow-up period was 87.97 (interquartile range: 19.5-181.4) months, and cLN patients had a lower renal survival rate. The 5 years renal survival rate of cLN and matched non-cLN patients were 30.6%, 77.2%, respectively (p < 0.001). There was no significant difference in overall survival rate between the two groups (p = 0.375). Wire-loop lesions and renal tubular atrophy >50% were identified as risk factors for ESRD in cLN patients. Elevated serum creatinine level at baseline was a risk factor for death in cLN patients.

cLN patients had worse treatment response and renal outcomes than non-cLN but the mortality risk was similar. The presence of wire-loop lesions and renal tubular atrophy >50% on renal biopsy may predict ESRD in cLN patients.