Prognostic Significance of Renal Crescents in Lupus Nephritis

Greater proportions of crescents on kidney biopsy were independently associated with adverse outcomes of renal progression in patients with lupus nephritis (LN), according to research published in Lupus.

It is generally accepted that renal biopsies revealing crescents in more than 50% of glomeruli are prognostic of poor outcomes in LN. However, less is known about disease outcomes with variable proportions of crescents. 

Wei Chen, MD, PhD, and colleagues from Sun Yat-sen University in Guangzhou, China examined the prognosis of patients with LN and different proportions of renal crescents in a single center, retrospective cohort study utilizing data from a hospital LN database, which included patients diagnosed with LN from 1996 to 2011.

Study event endpoints were defined by researchers as the doubling of baseline serum creatinine, diagnosis of end-stage renal disease, or patient death.

The 406 patients with crescents found on kidney biopsy had more severe LN disease phenotypes, with lower estimated glomerular filtration rates (eGFRs), increased proteinuria, microscopic hematuria, and higher pathological scores for both activity and chronicity when compared to patients with no crescents found on biopsy (all values P < .001).

“Higher proportions of crescents independently predicted adverse outcomes of renal progression after adjusting for age, sex, baseline eGFR, and proteinuria  in the multivariate Cox proportional hazard model”, the authors wrote.

After a median follow-up of 56 months (range  3–172 months), 16.8% of LN patients with crescents reached a predefined endpoint event, as compared to 13.9% of patients without crescents (not statistically significant).  Additionally, no significant differences were observed in overall survival in patients with crescents as compared to no crescents (P = .188).

The authors suggest that the lack of survival difference may have been attributed to intensive treatment received by systemic lupus erythematosus patients with class IV nephritis, including intravenous methylprednisolone, cyclophosamide, or mycophenolate mofetil.

Summary and Clinical Applicability

The long-term survival of patients with LN was comparable in patients with and without crescents on kidney biopsy.  There was a notable increase, however, in unfavorable outcomes in patients with an increased proportion of crescents.

“More attention should be paid to the lesions of crescents, and more prospective studies are needed to explore the optimal regimens for LN patients with different proportions of crescents,” the authors concluded.

Limitations and Disclosures

Conclusions presented in this research are limited by the retrospective design of the study as well as lack of control for treatment regimens.

Study authors had no conflicts of interest to disclose. 

This research was funded by the Ministry of Science and Technology of China, the National Natural Science Foundation of China, and Sun Yat-sen University.

Reference

Zhang W, Yuan M, Hong L, et al. Clinical outcomes of lupus nephritis patients with different proportions of crescents. Lupus. 2016; Published online before print April 7, 2016  doi: 10.1177/0961203316642312