Glomerular Crescents in Adult Lupus Nephritis: Clinical and Pathological Insights From Saudi Arabia

Crescent formation is a marker of severe kidney injury in lupus nephritis (LN), but data from Saudi Arabia are scarce. We studied how crescents affect clinical features, pathology, and outcomes in Saudi patients.

We reviewed 100 adults with biopsy-proven LN (2003-2024), classifying them by the presence and type of crescents (cellular, fibrocellular, fibrous). Crescent burden was calculated as the percentage of glomeruli involved; ≥ 7.39% was considered high. The composite renal outcome included estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m², ≥ 20% decline in eGFR, doubling of serum creatinine, or dialysis or transplant. Outcomes were analyzed using Kaplan-Meier curves and multivariable Cox regression.

Out of 100 patients with LN, 41 (41%) had crescents. Those with crescents had lower eGFR (71.41 ± 43.92 vs. 100.12 ± 45.63 mL/min/1.73 m², p = 0.002), lower albumin (25.51 ± 6.17 vs. 29.81 ± 7.56 g/L, p = 0.004), and higher activity scores (7.93 ± 3.05 vs. 2.27 ± 2.33, p < 0.001) than non-crescent patients; chronicity scores were similar. Kaplan-Meier curves suggested that patients with high crescent burden (≥ 7.39%) had worse event-free survival, but crescent burden was not an independent predictor. Instead, older age, higher baseline creatinine, elevated CRP, and fibrous crescents were linked to worse outcomes. Treatment response did not differ by crescent burden (p = 0.294).

Crescents indicate more active disease and worse kidney function at diagnosis. While a high crescent burden may signal poorer short-term outcomes, long-term prognosis depends more on other clinical and pathological factors. Assessing both clinical presentation and biopsy findings is important for managing LN.