Abstract:

Objective: Crescentic nephritis is not rare in diffuse proliferative lupus nephritis (DPLN). However, little is known about the clinicopathological features in DPLN with crescents worldwide. This study was undertaken to investigate the clinicopathological features and outcome of Chinese DPLN patients with different degree of crescents. Methodology: Five hundred and twenty DPLN patients with more than 10% histological crescents (cDPLN) were enrolled in this retrospective study. They were divided into three groups: group 1 (10%≤Crescent%<25, n=240), group 2 (25%≤Crescent%<50, n=160), and group 3 (Crescent%≥50, n=120). Another 100 patients without histological crescents were regarded as a control group. Their clinicopathological features, treatment response and outcome were compared among four groups. Results: They were 450 (86.6%) females and 70 (13.4%) males with an average age of 31.7±11.4ys. Compared with controls, cDPLN patients had shorter LN duration (20.7±34.1) vs (30.4±48.9)mths, higher prevalence of RPGN (21.8%), and gross hematuria (26.7%). Laboratory findings indicated more severe hypo-proteinemia, hyperlipoidemia, and renal insufficiency, heavier proteinuria and microscopic hematuria, higher levels of tubular injury parameters and lower serological activity in crescentic groups. Histologically, cDPLN patients had severe glomerular and tubulointerstitial lesions, extensive leukocyte infiltration, together with a lesser degree of immune complex deposition. Crescent ratio correlated positively with the ratio of serositis, hypertension, anemia, gross hematuria, positive ANCA, cappilary necrosis, the levels of blood urea nitrogen, creatinine, complement C3, C4, urinary NAG enzyme, RBP enzyme and AI, CI score, while correlated negatively with age, LN duration, SLE duration and the proportion of histological platinum ear phenomenon. Conclusions: cDPLN patients with acute onset and short disease duration mostly showed severe renal manifestations, less extra-renal organ involvement, lower serological activity, serious  capillary necrosis, severe tubulointerstitial inflammation, atrophy and fibrosis, prominent leukocyte infiltration and less glomerular immune complex deposition.

Key words: crescent, diffuse proliferative lupus nephritis, clinicopathologica