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The role of crescent formation in primary membranous nephropathy (PMN) and its potential impact on prognosis remain an area of ongoing investigation. This study stratifies patients with PMN into two cohorts: one with crescents and one without. It then compares these groups to investigate the influence of crescents on the prognosis of PMN. Methods: In this retrospective analysis, we included patients who had a confirmed diagnosis of PMN and exhibited crescents upon renal biopsy. The study population was sourced from the medical records at the Affiliated Hospital of Guangdong Medical University in Zhanjiang, China, spanning from January 2017 to June 2023. To enable a comparative analysis of clinical, pathological, and prognostic features, a control group was established, comprising 106 patients diagnosed with PMN who did not have crescent formation. These controls were randomly selected from the same time frame. Regular follow-up of the patients continued in the outpatient setting for at least six months. Results: A total of 53 patients with PMN and crescent formation were included in this study, while 106 individuals without crescents served as a randomly selected control group. Patients with PMN and crescents exhibited higher systolic blood pressure (P = 0.015), 24-hour proteinuria (P = 0.006), serum creatinine (P = 0.029) levels, and lower glomerular filtration rate (P = 0.002), compared to those without crescents. Histological examination revealed a higher proportion of focal segmental sclerosis (P < 0.001), spherical sclerosis (P < 0.001), arteriosclerosis (P = 0.02), and interstitial fibrosis with tubular necrosis (P = 0.002) in patients with PMN and crescent formation. Immunofluorescence staining demonstrated a weaker IgG4 fluorescence intensity in patients with PMN and crescent formation. At the end of the follow-up period, patients with PMN and crescents had a lower remission rate (P = 0.022), poorer renal function (P = 0.007), and lower albumin (P = 0.039) levels. Kaplan-Meier (KM) analysis identified proteinuria and crescent formation as independent risk factors for adverse outcomes in patients with PMN (P < 0.001 and P < 0.05). Immunohistochemistry staining revealed positive expression of CD68 and CD20 in the renal interstitium of patients with PMN, regardless of the presence of crescents. Conclusion: Crescent formation is associated with a risk of adverse outcomes in patients with PMN. Patients with crescents exhibit severe clinical and pathological features and have poorer prognoses. [ABSTRACT FROM AUTHOR]

Background: Crescent formation is a serious pathological change in the IgA nephropathy (IgAN) which is believed to be primarily mediated by a mixture of parietal epithelial cells, macrophages, and myofibroblasts. It was recommended that IgAN patients with rapid renal hypofunction with a crescent body >50% should begin treatment with corticosteroids combined with cyclophosphamide. However, for patients with partial crescent formation, whether immunosuppressive therapy is necessary is a contested topic., Materials and Methods: Data from IgAN patients with partial crescent formation who underwent repeat renal biopsy were retrospectively analyzed., Results: From the first to the second renal biopsy, the mean hemoglobin level and albumin level increased significantly (P < 0.05), and uric acid and triglyceride levels decreased significantly (P < 0.05). Also, the 24-hour urinary protein excretion decreased significantly (P < 0.001), but no differences in blood pressure, creatinine level, or estimated glomerular filtration rate. For pathological indices, there were no differences in fluorescence intensity of IgA or C3 deposition (P > 0.05), but the mesangial cell proliferation decreased significantly (P < 0.05), and the proportions of global glomerulosclerosis and tubulointerstitial fibrosis increased significantly (P < 0.05, respectively). In addition, a decreased tendency in the proportion of crescent formation was observed in the second renal biopsy., Conclusions: Immunosuppressive therapy for IgAN patients with partial crescent formation can reduce proteinuria, stabilize renal function, improve anemia, and mitigate acute kidney injury in the short term.

The present study aimed to evaluate the effects of an individualized, low-dose multi-drug immunosuppressive regimen for the treatment of immunoglobulin A nephropathy (IgAN). A preliminary investigation of the course of IgAN following immunosuppressive treatment was conducted based on repeat renal biopsies. Clinical and pathological data of 17 patients with IgAN who received repeat renal biopsies were analyzed retrospectively. In addition to basic treatment, 16 patients regularly received an individualized low-dose immunosuppressive regimen according to their clinical manifestations and pathological patterns following the first biopsy. Clinical parameters, including 24-h urinary protein excretion and levels of serum albumin, uric acid and total cholesterol were collected. Glomerular deposits of IgA and C3, as well as the activity and chronicity indexes of renal lesions were evaluated by semi-quantitative methods. The 24-h urinary protein excretion of the patients decreased significantly from the first biopsy (2.53±2.17 g/day) to the repeated biopsy (0.26±0.55 g/day) (P<0.001). Deposits of IgA and C3 in the glomerulus were persistent, but were reduced in quantity at the second biopsy. Although active renal lesions were observed in the majority of patients, the activity index decreased significantly from 3.18±1.33 prior to therapy to 2.47±0.80 following therapy (P<0.05), while the chronicity index did not change significantly (2.59±2.00 versus 2.76±1.89, respectively). The individualized, low-dose multi-drug immunosuppressive regimen used in the present study significantly minimized proteinuria, stabilized renal function and alleviated histological lesions in patients with IgAN without causing overt adverse effects during the short-term follow-up. In addition to proteinuria, renal pathological changes should be appraised when considering the withdrawal of immunosuppressants from IgAN treatment.