Abstract: SA-PO0841
Crescent Burden and Rapidly Progressive Glomerulonephritis Predict Kidney Survival in Patients with Lupus Nephritis: A Latin American Cohort
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Rodelo Ceballos, Joaquin, Hospital Universitario San Vicente de Paul, Medellín, Antioquia, Colombia
- Restrepo-Escobar, Mauricio, Universidad de Antioquia, Medellín, Antioquia, Colombia
Background
Crescent formation and rapidly progressive glomerulonephritis (RPGN) are severe phenotypes of lupus nephritis (LN), but their impact on kidney survival remains unclear in Latin American populations. We evaluated the association of cellular/fibrocellular crescents and clinical RPGN with progression to end-stage kidney disease (ESKD) in biopsy-proven LN.
Methods
We conducted a retrospective cohort study of patients aged ≥14 years with biopsy-proven LN treated at a tertiary referral center in Medellín, Colombia (2011-2024). Crescent burden was categorized as absent, ≤10%, 11-20%, and >21% of glomeruli. Kidney survival free from ESKD was evaluated using Kaplan-Meier and log-rank tests. Cox and Fine-Gray competing risk models (death as competing event) were adjusted for age, sex, baseline CKD-EPI eGFR, proliferative LN, chronicity index, induction therapy, and crescents.
Results
The cohort included 464 patients; 79 developed ESKD. Kidney survival progressively declined with increasing crescent burden (global log-rank p<0.001). Five-year kidney survival was 90.4% without crescents, 72.4% with ≤10%, 69.6% with 11-20%, and 58.9% with >21% crescents. In multivariable Cox models, lower baseline eGFR and higher chronicity index were independently associated with ESKD. Similar findings were observed in competing risk analyses.
Conclusion
Crescent burden was strongly associated with worse kidney survival in LN, showing a graded relationship with progression to ESKD. Baseline kidney function and histologic chronicity remained major determinants of prognosis, supporting incorporation of extracapillary lesions into risk stratification.
Kidney survival free from ESKD at 1, 3, and 5 years by crescent burden
| Crescent Burden | n | ESKD Events | 1-Year Kidney Survival | 3-Year Kidney Survival | 5-Year Kidney Survival | Log-Rank P value |
| None | 317 | 35 | 93.3% | 91.4% | 90.4% | <0.001 |
| ≤ 10% | 82 | 24 | 81.4% | 74.3% | 72.4% | <0.001 |
| 11-20% | 39 | 11 | 86.9% | 80.6% | 69.6% | <0.001 |
| ≥ 21% | 26 | 9 | 72.5% | 67.3% | 58.9% | <0.001 |