Crescents and CKD progression in diabetic nephropathy.

Objectives: Crescents play important roles in the pathophysiology of patients with biopsy-proven diabetic nephropathy (DN). However, their relationship to disease severity and progression has not been fully clarified.

Methods: We assessed 142 participants in a retrospective cohort study of biopsy-proven DN. We determined associations of crescent formation with CKD progression event, defined as a sustained decrease from baseline of at least 40% in the eGFR or ESRD, using Cox proportional hazards models. A prognostic nomogram was constructed to predict 1-, 3-, and 5-year renal survival for patients with DN.

Results: Glomerular crescent formation negatively correlated with eGFR (Spearman's ρ=-0.33, P=0.01), whereas there was no significant correlation between crescents and 24-hour proteinuria, KW nodules, capillary microaneurysms, and C3 deposition. After adjustment for traditional risk factors (demographics, eGFR, proteinuria, and pathologic score), the crescents were independently associated with a CKD progression event (HR, 1.71; 95% CI, 1.07-2.76; P=0.024). Moreover, the risk of CKD progression events was greater with a higher proportion of crescents but reached a plateau when the crescent proportion was 20%.

Conclusions: In patients with DN, crescents were associated with CKD progression events independent of clinical and pathologic characteristics.