Glomerular crescents are associated with the risk of type 2 diabetic kidney disease progression: a retrospective cohort study

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Abstract Background Diabetic kidney disease (DKD) stands as the predominant cause of chronic kidney disease and end-stage kidney disease. Its diverse range of manifestations complicates the treatment approach for patients. Although kidney biopsy is considered the gold standard for diagnosis, it lacks precision in predicting the progression of kidney dysfunction. Herein, we addressed whether the presence of glomerular crescents is linked to the outcomes in patients with biopsy-confirmed type 2 DKD. Methods A comprehensive review was conducted, involving 327 patients diagnosed with biopsy-confirmed DKD in the context of type 2 diabetes, excluding cases with other glomerular diseases, from nine tertiary hospitals. Hazard ratios (HRs) were calculated using a Cox regression model to assess the risk of kidney disease progression, defined as either ≥ 50% decrease in estimated glomerular filtration rates or the development of end-stage kidney disease, based on the presence of glomerular crescents. Results Out of ten patients (3.1%), glomerular crescents were observed in their biopsied tissues. Over the follow-up period (median of 19 months, with a maximum of 18 years), the crescent group exhibited a higher risk of kidney disease progression than the no crescent group, with an adjusted HR of 2.82 (1.32–6.06) (P = 0.008). The presence of heavy proteinuria was associated with an increased risk of developing glomerular crescents. Conclusion The presence of glomerular crescents is indeed linked to the progression of type 2 DKD. Therefore, it may be necessary to include histological monitoring of glomerular crescents in the management of patients to provide more intensive treatment.

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