Abstract
BACKGROUND: Crescentic lupus nephritis (cLN) is an uncommon and severe phenotype in LN with limited data on outcomes and relevant risk factors. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.