Introduction
Crescentic #glomerulonephritis (GN) is among the most aggressive glomerular diseases, defined by extensive crescent formation and rapid loss of kidney function.
Objective
To evaluate clinical, laboratory, and histopathologic determinants of end-stage kidney disease (ESKD) and overall survival (OS), and to identify associated factors of poor outcomes in patients with crescentic GN (cGN) and GN with crescent formation.
Methods
This single-center retrospective cohort included 194 adults who underwent kidney biopsy between 2005 and 2024. The primary endpoints were progression to ESKD and OS. Cox proportional hazards and Kaplan – Meier analyses were performed.
Results
Immune complex GN was the predominant subtype (59.3%), followed by pauci-immune GN (38.1%) and anti-GBM disease (2.6%). cGN accounted for 25.2% of cases. Overall, 42.8% of patients progressed to ESKD, while 35.6% died during follow-up. In multivariate Cox analysis, maintenance steroid monotherapy was a strong independent associated factor of ESKD (HR 2.349, 95% CI 1.378–4.004, p = 0.002), along with baseline creatinine (HR 1.180, 95% CI 1.023–1.360, p = 0.023), proteinuria (HR 1.067, 95% CI 1.020–1.117, p = 0.005), global glomerulosclerosis (HR 4.103, 95% CI 1.083–15.540, p = 0.038), and IgA positivity (HR 0.758, 95% CI 0.587–0.979, p = 0.034). For OS, steroid monotherapy remained independently associated with mortality (HR 2.427, 95% CI 1.370–4.299, p = 0.002), along with older age and reduced eGFR.
Conclusion
Maintenance #steroid monotherapy was the strongest treatment-related factor associated with both ESKD and overall survival, highlighting the potential risks of inadequate maintenance immunosuppression in high-risk patients.
https://www.tandfonline.com/doi/full/10.1080/17843286.2026.2633340
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