Clinicopathologic characteristics and long-term outcomes in glomerulonephritis with crescent formation: a 20-year single-center cohort study

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.