Clinicopathological features and outcomes of different proportions and types of crescent in patients with grade Ⅲ IgA vasculitis nephritis

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The proportion of the crescent from 0 to 50% is broad in grade Ⅲ IgAVN. The present study aimed to analyze the clinicopathological features and outcomes of different proportions and types of crescent in grade Ⅲ IgAVN patients. Methods From January 2020 to December 2024, 442 patients with grade Ⅲ IgAVN were enrolled in this retrospective study. The patients were divided into two groups on the basis of crescent proportion: < 25% and 25%≤crescent<50%. According to the crescent type, the patients were divided into three groups: acute, subacute and chronic crescent groups. The clinicopathological features and outcome were compared among groups. Results Compared with crescent <25% group，urinary occult blood, proteinuria, urinary N-acetyl-beta-D-glucosaminidase (NAG), blood urea nitrogen (BUN), tubulointerstium injury rate and tubulointerstium injury scores all increased significantly, and estimated glomerular filtration rate (eGFR) decreased siginificantly in 25%≤crescent<50% group. Compared with acute crescent group, percentage of crescent, tubulointerstium injury rate and scores increased, eGFR and percentage of endocapillary proliferation decreased in subacute group, but proteinuria, urinary NAG and BUN were no difference between acute and subacute groups. Compared with acute and subacute groups, proteinuria in the chronic crescent group decreased significantly and chronic tubulointerstium score increased significantly. Follow up for 1 to 4 years, patients with 25%≤crescent<50% had higher incidence of end-stage renal disease (ESRD) than crescent<25% group, and patients in subacute and chronic crescent groups had higher incidence of ESRD than acute crescent group. Conclusions Different proportions and types of crescent in patients with grade Ⅲ IgAVN had different clinicopathological features and outcomes. It is necessary to refine and score the proportion and type of crescents in pathological diagnosis of IgAVN patients. IgA vasculitis nephritis Crescent Clinicopathology Outcome Figures Figure 1 Figure 2 Figure 3 Background IgA vasculitis nephritis (IgAVN) is the most common childhood glomerular diseases and are characterized by significant variability in clinical manifestations and pathological changes [ 1 ]. Pathologic features of IgAVN is usually graded by the International Study of Kidney Disease in Children (ISKDC) classification, mainly according to the existence and the proportion of crescents [ 2 ]. However, the value of crescents in predicting long-term outcome of IgAVN is still lack of consensus and ISKDC classification has limited prognostic value [ 3 , 4 ]. Most biopsies fall into ISKDC grade Ⅲ and it is broad that the proportion of crescent ranges from 1% to 50% [ 5 – 8 ]. Crescent is also common in renal tissues of IgA nephropathy and lupus nephritis. The proportion of crescent less than 25% and 25%≤crescent < 50% have different pathological scores in IgA nephropathy and lupus nephritis [ 9 , 10 ]. According to formation components, crescents are usually classified into cellular, fibrocellular and fibrous crescent [ 11 ]. Cellular and fibrocelluar crescents are classified as active lesions and have the same score in IgA nephropathy and lupus nephritis [ 9 , 10 ]. However, Fibrocelluar crescent are usually accompanied by rupture of the Bowman's capsule, and the lesion involves the renal interstitium [ 12 ]. Patients with the same proportion of cellular crescents and fibrocelluar crescents may have different renal outcomes. In this study, we analyze the clinicopathological features of different proportions and types of crescent in patients with grade Ⅲ IgAVN. Materials and methods Study population We reviewed the medical records of 442 IgAVN patients with 0%<crescent < 50% formation at our hospital between January 2020 to December 2024. The inclusion criteria were: (1) proteinuria, hematuria, and/or renal failure associated with purpura with/without joint or abdominal pain, (2) renal specimens with more than 10 glomeruli, (3) 0%<crescent < 50%, (4) The follow-up period was more than 1 year. The exclusion criteria were patients with thrombocytopenic purpura, other systemic diseases or other primary and secondary glomerulonephritis. The patients were divided into two groups on the basis of crescent proportion: <25% and 25%≤crescent < 50%. According to the crescent type, the patients were divided into three groups: acute, subacute, and chronic crescent groups. Acute group include patients with only cellular crescent, subacute group include patients with cellular crescent and fibrocellular crescent or fibrous crescent, and chronic group include patients with fibrocellular crescent and/or fibrous crescent. Clinical and laboratory data at biopsy The following features were collected from the medical records: age, gender, time since kidney disease onset, blood pressure, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urinary total protein (UTP), urinary N-acetyl-beta-D-glucosaminidase (NAG), and renal pathology data. The values of UTP and NAG were rectified using urinary creatinine. Values of the above parameters measured at or near the time of renal biopsy were used for analysis. The eGFR was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal insufficiency was defined as eGFR < 60 mL/min/1.73 m 2 . Renal pathological data at biopsy Kidney tissue sections were observed and scored independently by two separate pathologists who were blinded from patient data. The histopathological changes of IgAVN are classified by ISKDC into six categories [ 2 ]. Cellular crescent was defined as extracapillary hypercellularity of > 2 cell layers and involving > 10% of the capsular circumference, composed of > 75% cells with or without fibrin, and 10% of the capsular circumference [ 11 ]. Fibrous crescent was defined as extracapillary fibrosis composed of > 75% matrix and of 10% of the capsular circumference [ 11 ]. Tubulointerstitial injuries were categorized into acute and chronic injury. Tubulitis, interstitial edema and inflammation were defined as acute injuries, while tubular atrophy and interstitial fibrosis were classified as chronic injuries. The rate of tubulointerstitial injury was statistically analyzed. Because the cases in this group are mainly children, the severity of acute and chronic tubulointerstitial injuries was scored based on the area of tubulointerstitial injury: Score 0: Normal; Score 1: ≤5%; Score 2: ≤10%; Score 3: ≤25% Score 4: ≤50%; Score 5: >50% [ 8 ]. Outcomes Patients were followed up for more than 1 year. Outcomes were classified into the following four grades[ 13 , 8 ]. A) Normal, no hypertension, proteinuria qualitative reaction (–) or UTP ≤ 20mg/mmol, no microscopic or macroscopic hematuria, and normal renal function; B) Minor urinary abnormalities, UTP > 20mg/mmol and ≤ 67mg/mmol; C) Active kidney disease, UTP > 67mg/mmol, hypertension or elevated plasma creatinine with eGFR ≥ 60ml/min/1.73m 2 ; D) Chronic kidney disease (CKD), eGFR < 60ml/min/1.73 m 2 or death. A was considered as complete remission and D represented end stage renal disease (ESRD). Statistical analysis Statistical analyses were performed using SPSS 27.0. Continuous variables were tested for normality (Shapiro-Wilk test), with normal distributed data presented as mean ± SD and non-normal distributed data as median (IQR) [M (25th, 75th percentiles) ]. Categorical variables were compared using chi-square tests or Fisher’s exact tests. P < 0.05 was considered significant. Data visualization was performed using GraphPad Prism. Statistical significance was denoted by asterisks as follows: * P < 0.05, ** P < 0.01, *** P < 0.001, and **** P < 0.0001. Results Demographic characteristics of 442 patients with grade Ⅲ IgAVN A total of 442 patients with grade Ⅲ IgAVN were enrolled, including 333 children and 109 adults. At the time of biopsy, their median age was 12 years (IQR 9–17), and 51.58% were male. According to the proportion of crescents, patients were divided into two groups: crescent < 25% group (388 cases) and 25% ≤ crescent < 50% group (54 cases). According to the components of crescents, patients were divided into acute crescent group (180 cases), subacute crescent group (128 cases) and chronic crescent group (134 cases). There was no statistically significant difference in age and renal duration between crescent < 25% group and 25% ≤ crescent < 50% group, but the proportion of males increased siginificantly in 25% ≤ crescent < 50% group. Compared with acute crescent group, age and disease duration increased significantly in subacute group and chronic crescent group. (as shown in Table 1 ) Table 1 Baseline characteristics of 442 patients with grade Ⅲ IgAVN in the study Parameters Crescent < 25% (n = 388) 25% ≤crescent < 50% (n = 54) P Acute crescent (n = 180) Subacute crescent (n = 128) Chronic crescent (n = 134) P Gender (male/female) 208/180 20/34 0.0224 94/86 67/61 67/67 0.9078 Age (years) 12 (9–17) 13 (11–19) 0.2162 11 (9–15) 14 (10–18) 14 (10-19.25) 0.0001 Renal duration (days) 20 (3-142.5) 25.5 (8.75–315) 0.3445 10 (1–30) 30 (9-180) 47 (13.75–472.5) < 0.0001 UTP (mg/mmol) 114.5 (59.85–222.4) 177.9 (93.45–372.0) 0.0010 144.3 (83.7-286.5) 137 (75.39–290.9) 80.31 (49.10-149.6) < 0.0001 UNAG (U/g) 8.420 (5.725–13.20) 11.70 (8.06–20.73) 0.0002 8.865 (5.688–15.11) 10.21 (7.09–16.92) 7.77 (5.495–11.20) 0.0015 BUN (mmol/L) 4.155 (3.333–4.968) 5.255 (4.313–6.220) < 0.0001 4.225 (3.293–5.238) 4.36 (3.485–5.15) 4.24 (3.41–5.083) 0.8272 eGFR (mL/min/1.73 m 2 ) 127.3 (106.2-145.4) 118.1 (89.1-134.5) 0.0062 131 (107.6-147.8) 123.8 (97.2-140.1) 122.0 (100.9-142.1) 0.0147 TI injury rate (n, %) 233 (60.1%) 50 (92.6%) < 0.0001 83 (46.1%) 107 (83.6%) 93 (69.4%) < 0.0001 Total TI score 1 (0–2) 1.5 (1–2) < 0.0001 0 (0–1) 1 (1–2) 1 (0–2) < 0.0001 Acute TI score 0 (0–1) 1 (0–1) < 0.0001 0 (0–1) 1 (0–1) 0 (0–0) < 0.0001 Chronic TI score 0 (0–1) 0 (0–1) 0.1563 0 (0–0) 0 (0–1) 1 (0–2) < 0.0001 UTP: urinary total protein; UNAG: urinary N-acetyl-beta-D-glucosaminidase; BUN: blood urea nitrogen; eGFR: estimated glomerular filtration rate; TI: tubulointerstitial Comparison of laboratory indicators and pathological parameters between groups with different proportions of crescent Compared with crescent < 25% group, the patients in 25% ≤crescent < 50% group had higher urinary occult blood, UTP, UNAG, and blood urea levels, and had lower eGFR (Table 1 and Fig. 1 A-E). Compared with crescent < 25% group, the rate of tubulointerstitial injury and acute tubulointerstitial injury score increased significantly in 25% ≤crescent < 50% group (Table 1 and Fig. 1 G-H). There was no difference in percentage of endocapillary proliferation and chronic tubulointerstitial injury score between two groups (Fig. 1 F and Fig. 1 I). Comparison of laboratory indicators and pathological parameters among groups with different types of crescents The formation and evolution of the crescent is a progressive process. We divided all patients into three groups: acute crescent group, subacute crescent group, and chronic crescent group according to the components of the crescents. Compared with acute crescent group, the patients in subacute crescent group had higher percentage of crescent, rate of tubulointerstitial injury, acute tubulointerstitial injury score and chronic tubulointerstitial injury score, but had lower percentage of endocapillary proliferation and eGFR. There are no difference in UTP and UNAG between acute crescent group and subacute crescent group. Compared with acute crescent group and subacute crescent group, patients in chronic crescent group had lower UTP, UNAG, percentage of endocapillary proliferation and acute tubulointerstitial injury score. Compared with acute crescent group, rate of tubulointerstitial injury and chronic tubulointerstitial injury score increased significantly in the chronic crescent group. Compared with subacute crescent group, chronic crescent group had lower percentage of crescent, higher chronic tubulointerstitial injury score and similar eGFR level. (Table 1 and Fig. 2 ) Comparison of treatments among groups with different proportions and types of crescents in patients with grade Ⅲ IgAVN In total, 203 patients were treated with oral prednisone plus tripterysium glycosides, 117 patients were treated with oral prednisone, 57 patients were treated with oral prednisone plus kunxian capsule, 31 patients were treated with prednisone plus mycophenolate mofetil, 22 patients were treated with methylprednisolone pulse treatment, 12 patients were treated with prednisone plus cyclophosphamide. Compared with crescent < 25% group, the proportions of patients treated with methylprednisolone pulse and prednisone plus cyclophosphamide increased significantly in 25%≤ crescent < 50% group. Compared with acute crescent and chronic crescent groups, the proportions of patients treated with methylprednisolone pulse and prednisone plus cyclophosphamide increased significantly in subacute crescent group. Table 2 shows treatment after renal biopsy and outcomes of different groups. Table 2 Treatments and outcomes of 442 patients with grade Ⅲ IgAVN in the study Treatment Crescent < 25% 25% ≤ crescent < 50% P Acute crescent Subacute crescent Chronic crescent P 0.0001 0.0131 Prednisone/methylprednisolone (n, %) 107 (27.5%) 10 (18.5%) 49 (27.2%) 30 (23.4%) 38 (28.4%) Prednisone + tripterysium glycosides (n, %) 179 (46.1%) 24 (44.4%) 90 (50.0%) 57 (44.5%) 56 (41.8%) Prednisone + Kunxian capsule (n, %) 52 (13.4%) 5 (9.3%) 23 (12.8%) 14 (10.9%) 20 (14.9%) Prednisone + mycophenolate mofetil (n, %) 29 (7.5%) 2 (3.7%) 10 (5.5%) 7 (5.5%) 14 (10.4%) Methylprednisolone pulse treatment (n, %) 13 (3.4%) 9 (16.7%) 7 (3.9%) 12 (9.4%) 3 (2.2%) Prednisone + cyclophosphamide (n, %) 8 (2.1%) 4 (7.4%) 1 (0.6%) 8 (6.3%) 3 (2.2%) Outcomes 0.0288 0.0157 A (n, %) 67 (20.5%) 5 (10.6%) 32 (20.8%) 15 (13.8%) 25 (22.5%) B (n, %) 99 (30.3%) 14 (29.8%) 40 (26.0%) 33 (30.3%) 40 (36.0%) C (n, %) 155 (47.4%) 24 (51.1%) 82 (53.2%) 56 (51.4%) 41 (36.9%) D (that is ESRD) (n, %) 6 (1.8%) 4 (8.5%) 0 (0.0%) 5 (4.6%) 5 (4.5%) Comparison of outcomes among groups with different proportions and types of crescents in patients with grade Ⅲ IgAVN We followed up the patients for more than one year. The results showed that compared with the crescent < 25% group, the prognosis of patients in the 25%≤crescent < 50% group was worse, and the incidence of ESRD was significantly higher (Table 2 and Fig. 3 A-B). The comparison results among groups with different crescent composition showed that compared with the acute crescent group, the prognosis of patients in subacute crescent group and chronic crescent group were worse, and the incidence of ESRD were significantly higher. The incidence of ESRD was no difference between subacute crescent group and chronic crescent group (Table 2 and Fig. 3 C-D). Nobody developed ESRD in acute crescent group. Discussion The proportion of crescent varies from 0% <crescent < 50% in grade Ⅲ IgAVN. In our study, patients with grade Ⅲ IgAVN were divided into two groups on the basis of crescent proportion: <25% and 25%≤crescent < 50%. our results show that patients in 25%≤crescent < 50% group had higher UTP, UNAG, BUN, rate of tubulointerstitial injury and acute tubulointerstitial injury score, and had lower eGFR. The research of Huang et al also showed that adult IgAVN patients with > 25% crescents had more-severe renal manifestations than patients with < 25% crescents[ 14 ]. In IgA nephropathy and lupus nephritis, the scores of crescents with a proportion < 25% and 25%≤crescent < 50% are different[ 9 , 10 ]. Diffuse endocapillary proliferation lesion is an independent pathogenic factor of nephrotic-range proteinuria in IgAVN[ 15 ]. There was no difference in percentage of endocapillary proliferation between two groups in this study, suggesting that crescents are an independent predictor of increased proteinuria. Although with similar renal duration, with the increase of the proportion of crescents in grade Ⅲ IgAVN, the rate of tubulointerstitial injury increases and renal function declines in our study. The above studies suggest that IgAVN patients with 25%≤crescent < 50% have more severe renal damage. To further clarify the influence of the crescent on the laboratory indicators in grade Ⅲ IgAVN, we divided patients into acute crescent group, subacute crescent group and chronic crescent group according to the crescent type. Our results showed that patients subacute crescent group had longer renal duration, higher percentage of crescent, higher acute and chronic tubulointerstitial injury scores, but had lower percentage of endocapillary proliferation and eGFR. There was no difference in UTP between acute crescent group and subacute crescent group. Similar UTP level may result from increased percentage of crescents, but with decreased percentage of endocapillary proliferation. Both glomerular crescent and endocapillary proliferation lesions are the main influencing factors of proteinuria. Although cellular crescents and fibrocellular crescents are uniformly scored and given the same meaning in lupus nephritis and IgA nephropathy[ 9 , 10 ]. Fibrocelluar crescent formation mean rupture of the Bowman's capsule and glomerular injury involves tubulointerstitium, and cytotoxic CD8 + T cells from interstitium migration into glomerulus, resulting in glomerular tuft and podocytes futher injury[ 16 , 17 ]. Compared with acute crescent group, eGFR was decreased in subacute crescent group and chronic crescent group, and there was no difference in eGFR between subacute crescent group and chronic crescent group. Above results suggest that different crescent type have distinct clinicopathological and laboratory characteristics and should be treat differently in grade Ⅲ IgAVN. The utility of crescents as a predictor of renal outcome in IgAVN was long-debated. Crescents were related with poor prognosis in some studies[ 18 , 19 ], but it was not confirmed by others in IgAVN[ 20 , 21 ]. Our results showed that compared with the crescent < 25% group, the prognosis of patients in the 25%≤crescent < 50% group was worse and the incidence of ESRD was significantly higher despite undergoing intensive treatment. Inconsistent results may be related to sample size, patient population, indications for renal biopsy and different crescent types. Similar situation occurs in IgA nephropathy[ 22 – 24 ]. Crescents were relatively rare in IgA nephropathy and were not used as a parameter in the Oxford classification until its recent update. Two recent systematic review and meta-analysis showed that significantly increased risks of kidney outcomes were observed with a crescent proportion > 10% and > 25%, and proportion > 25% also displayed an elevated risk of ESRD in IgA nephropathy [ 19 , 25 ]. The study of Du Y et al showed that crescents ≥ 25% was an independent risk factor for ≥ 50% reduction in eGFR or ESKD in treated and untreated IgA nephropathy patients [ 26 ]. Cellular crescents can dissipate after active treatment, while fibrocellular crescents may retain varying degrees of fibers, resulting in fibrous crescents or adhesions despite active treatment. The appearance of fibrocelluar crescent indicates the progression of the disease, involvement of renal tubulointerstitium. Our reslults showed that compared with the acute crescent group, the prognosis of patients in subacute crescent group and chronic crescent group was worse, and the incidence of ESRD was significantly higher. The incidence of ESRD was no difference between subacute crescent group and chronic crescent group, and no patient cccured ESRD in acute crescent group in our study. In conclusion, IgAVN patients with 25%≤crescent < 50% have more severe renal damage and worse outcomes than patients with < 25% crescent. Therefore, pathological grade Ⅲ of IgVAN should be further refined. The appearance of fibrocelluar crescent indicates the progression of the disease, involvement of renal tubulointerstitium and an increase of incidence of ESRD. Cellular crescent, fibrocellular crescent and fibrous crescent should be separately counted to better reflect their value in guiding treatment and predicting prognosis in pathological diagnosis. Declarations Ethics approval and consent to participate Ethical review committee of the First Affiliated Hospital of Henan University of Chinese Medicine approved the study with number 2023HL-512-01 and considering the retrospective review of charts, consent from the study participants was waived. The study followed ethical principles of declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding Sources This work was supported by Joint Fund Project of Science and Technology Research and Development Plan of Henan Province (232301420090), and The Scientific and Technological Innovation Guidance Plan for the Medical and Health Field of Zhengzhou City (2025YLZDJH316) Author Contribution XQ Y and XQ R proposed the initial concept and contributed to the first draft; QS Z were responsible for analysis and interpretation of the data; YL Y were responsible for the collection the data; Y D and X Z reviewed and provided critical feedback on manuscript drafts. All authors approved the final version of the manuscrip. Data Availability All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author. References Vivarelli M, Samuel S, Coppo R, Barratt J, Bonilla-Felix M, Haffner D, et al. 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Association between different proportions of crescents and adverse renal outcomes in immunoglobulin a nephropathy: a systematic review and meta-analysis. Ren Fail. 2025;47(1). Du Y, Chen S, Wang F, Zhang P, Liu M, Liu C et al. The Significance of Crescents on the Clinical Features and Outcomes of Primary Immunoglobin A Nephropathy. Front Med. 2022;9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9134664","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619721571,"identity":"f5257f87-21d5-4e46-8a2c-3d89ad6c5566","order_by":0,"name":"Xiaoqing Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqing","middleName":"","lastName":"Yang","suffix":""},{"id":619721572,"identity":"2bbcf03d-325e-4c7c-8829-1cb760105bf7","order_by":1,"name":"Qiushuang Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qiushuang","middleName":"","lastName":"Zhang","suffix":""},{"id":619721573,"identity":"2c4ad028-304b-401f-b6b4-f18460655736","order_by":2,"name":"Xianqing Ren","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBAC+wYgwfjPxo6fmfnwA6K0GBwAkWxpyZLtbGkGpGg5zLjhPI+CBHFajvcek3jDw8xsfJiHwYChxiaaoBb7nnPJhnMk2PjMDvMeeMBwLC23gZAWO4kcw8c8BjzMZof5EgwYGw4T1mIs/8bgME+CBOPmZh4DCaK0GM7gAdpywIBxAzOxWgzO5Bgbzm1ISJY4DAzkBGL8YnD8jJnE24b/dvz9hw8/+FBjQ1gLGPDAGAlEKUfRMgpGwSgYBaMAGwAAQjk8oh5rgYUAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Xianqing","middleName":"","lastName":"Ren","suffix":""},{"id":619721574,"identity":"0e3d1855-2faa-4b84-8cc9-c5370558acc6","order_by":3,"name":"Yueli Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yueli","middleName":"","lastName":"Yang","suffix":""},{"id":619721575,"identity":"ee671938-dcc1-483c-a929-8948cf176ba1","order_by":4,"name":"Ying Ding","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Ding","suffix":""},{"id":619721576,"identity":"3a48ce21-223e-445c-be54-02014cc40ed5","order_by":5,"name":"Xia Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-03-16 07:54:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9134664/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9134664/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106579838,"identity":"f18e172a-b626-4595-a4f1-cc02a55067e9","added_by":"auto","created_at":"2026-04-10 06:34:31","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5129909,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of laboratory indicators and pathological indexes between crescent \u0026lt; 25% group and 25%≤crescent\u0026lt;50% group.\u003c/strong\u003e (A) Urinary occult blood (B) UTP levels (C) Urinary NAG levels (D) BUN levels (E) eGFR (F) Percentage of endocapillary proliferation (G) Rate of renal tubulointerstitial injury (H) Score of acute renal tubulointerstitial injury (I) Score of chronic renal tubulointerstitial injury. (ns, Not Significant, * \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01, *** \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001, **** \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9134664/v1/189e776eeae739d262ab7df6.jpeg"},{"id":106725820,"identity":"b1744f09-f721-4c80-a03c-b96e9bd01034","added_by":"auto","created_at":"2026-04-12 18:34:00","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6251506,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of laboratory indicators and pathological indexes among groups with different types of crescents\u003c/strong\u003e. (A) Urinary RBC levels (B) Urinary UPCR levels (C) Urinary NAG levels (D) BUN levels (E) eGFR (F) Percentage of endocapillary proliferation (G) Rate of renal tubulointerstitial injury (H) Score of acute renal tubulointerstitial injury (I) Score of chronic renal tubulointerstitial injury. (ns, Not Significant, * \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01, *** \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, **** \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001)\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9134664/v1/68dc25d52a1c7af38bb5351e.jpeg"},{"id":106725930,"identity":"bd4fb3a4-87c5-4466-bdf7-95d20a85e4d4","added_by":"auto","created_at":"2026-04-12 18:34:32","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":96054,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of outcomes among groups with different proportions and types of crescents.\u003c/strong\u003e (A-B) Long-term outcomes in crescent＜25% group and 25%≤crescent \u0026lt;50% group. (C-D) Long-term outcomes in acute crescent group, subacute crescent group and chronic crescent group. (* \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05)\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9134664/v1/02dc8e51dc836ece6538c226.jpeg"},{"id":106727420,"identity":"31ce2076-14df-411f-b31b-edf42c69a784","added_by":"auto","created_at":"2026-04-12 18:38:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":12606872,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9134664/v1/95e46756-587d-404f-8ef6-d3a28bbb4cc4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinicopathological features and outcomes of different proportions and types of crescent in patients with grade Ⅲ IgA vasculitis nephritis","fulltext":[{"header":"Background","content":"\u003cp\u003eIgA vasculitis nephritis (IgAVN) is the most common childhood glomerular diseases and are characterized by significant variability in clinical manifestations and pathological changes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pathologic features of IgAVN is usually graded by the International Study of Kidney Disease in Children (ISKDC) classification, mainly according to the existence and the proportion of crescents [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the value of crescents in predicting long-term outcome of IgAVN is still lack of consensus and ISKDC classification has limited prognostic value [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Most biopsies fall into ISKDC grade Ⅲ and it is broad that the proportion of crescent ranges from 1% to 50% [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCrescent is also common in renal tissues of IgA nephropathy and lupus nephritis. The proportion of crescent less than 25% and 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% have different pathological scores in IgA nephropathy and lupus nephritis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to formation components, crescents are usually classified into cellular, fibrocellular and fibrous crescent [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Cellular and fibrocelluar crescents are classified as active lesions and have the same score in IgA nephropathy and lupus nephritis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, Fibrocelluar crescent are usually accompanied by rupture of the Bowman's capsule, and the lesion involves the renal interstitium [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Patients with the same proportion of cellular crescents and fibrocelluar crescents may have different renal outcomes. In this study, we analyze the clinicopathological features of different proportions and types of crescent in patients with grade Ⅲ IgAVN.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eWe reviewed the medical records of 442 IgAVN patients with 0%\u0026lt;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% formation at our hospital between January 2020 to December 2024. The inclusion criteria were: (1) proteinuria, hematuria, and/or renal failure associated with purpura with/without joint or abdominal pain, (2) renal specimens with more than 10 glomeruli, (3) 0%\u0026lt;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50%, (4) The follow-up period was more than 1 year. The exclusion criteria were patients with thrombocytopenic purpura, other systemic diseases or other primary and secondary glomerulonephritis. The patients were divided into two groups on the basis of crescent proportion: \u0026lt;25% and 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50%. According to the crescent type, the patients were divided into three groups: acute, subacute, and chronic crescent groups. Acute group include patients with only cellular crescent, subacute group include patients with cellular crescent and fibrocellular crescent or fibrous crescent, and chronic group include patients with fibrocellular crescent and/or fibrous crescent.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical and laboratory data at biopsy\u003c/h3\u003e\n\u003cp\u003eThe following features were collected from the medical records: age, gender, time since kidney disease onset, blood pressure, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urinary total protein (UTP), urinary N-acetyl-beta-D-glucosaminidase (NAG), and renal pathology data. The values of UTP and NAG were rectified using urinary creatinine. Values of the above parameters measured at or near the time of renal biopsy were used for analysis. The eGFR was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal insufficiency was defined as eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eRenal pathological data at biopsy\u003c/h3\u003e\n\u003cp\u003eKidney tissue sections were observed and scored independently by two separate pathologists who were blinded from patient data. The histopathological changes of IgAVN are classified by ISKDC into six categories [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Cellular crescent was defined as extracapillary hypercellularity of \u0026gt;\u0026thinsp;2 cell layers and involving\u0026thinsp;\u0026gt;\u0026thinsp;10% of the capsular circumference, composed of \u0026gt;\u0026thinsp;75% cells with or without fibrin, and \u0026lt;\u0026thinsp;25% fibrous matrix [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Fibrocellular crescent was defined as composed of 25%\u0026ndash;75% cells with or without fibrin, and the remainder fibrous matrix, involving\u0026thinsp;\u0026gt;\u0026thinsp;10% of the capsular circumference [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Fibrous crescent was defined as extracapillary fibrosis composed of \u0026gt;\u0026thinsp;75% matrix and of \u0026lt;\u0026thinsp;25% cells with or without fibrin, involving\u0026thinsp;\u0026gt;\u0026thinsp;10% of the capsular circumference [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Tubulointerstitial injuries were categorized into acute and chronic injury. Tubulitis, interstitial edema and inflammation were defined as acute injuries, while tubular atrophy and interstitial fibrosis were classified as chronic injuries. The rate of tubulointerstitial injury was statistically analyzed. Because the cases in this group are mainly children, the severity of acute and chronic tubulointerstitial injuries was scored based on the area of tubulointerstitial injury: Score 0: Normal; Score 1: \u0026le;5%; Score 2: \u0026le;10%; Score 3: \u0026le;25% Score 4: \u0026le;50%; Score 5: \u0026gt;50% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003ePatients were followed up for more than 1 year. Outcomes were classified into the following four grades[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A) Normal, no hypertension, proteinuria qualitative reaction (\u0026ndash;) or UTP\u0026thinsp;\u0026le;\u0026thinsp;20mg/mmol, no microscopic or macroscopic hematuria, and normal renal function; B) Minor urinary abnormalities, UTP \u0026gt;\u0026thinsp;20mg/mmol and \u0026le;\u0026thinsp;67mg/mmol; C) Active kidney disease, UTP\u0026thinsp;\u0026gt;\u0026thinsp;67mg/mmol, hypertension or elevated plasma creatinine with eGFR\u0026thinsp;\u0026ge;\u0026thinsp;60ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e; D) Chronic kidney disease (CKD), eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e or death. A was considered as complete remission and D represented end stage renal disease (ESRD).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 27.0. Continuous variables were tested for normality (Shapiro-Wilk test), with normal distributed data presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and non-normal distributed data as median (IQR) [M (25th, 75th percentiles) ]. Categorical variables were compared using chi-square tests or Fisher\u0026rsquo;s exact tests. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. Data visualization was performed using GraphPad Prism. Statistical significance was denoted by asterisks as follows: * \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, and **** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of 442 patients with grade Ⅲ IgAVN\u003c/h2\u003e \u003cp\u003eA total of 442 patients with grade Ⅲ IgAVN were enrolled, including 333 children and 109 adults. At the time of biopsy, their median age was 12 years (IQR 9\u0026ndash;17), and 51.58% were male. According to the proportion of crescents, patients were divided into two groups: crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group (388 cases) and 25% \u0026le; crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group (54 cases). According to the components of crescents, patients were divided into acute crescent group (180 cases), subacute crescent group (128 cases) and chronic crescent group (134 cases). There was no statistically significant difference in age and renal duration between crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group and 25% \u0026le; crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group, but the proportion of males increased siginificantly in 25% \u0026le; crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group. Compared with acute crescent group, age and disease duration increased significantly in subacute group and chronic crescent group. (as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of 442 patients with grade Ⅲ IgAVN in the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrescent\u0026thinsp;\u0026lt;\u0026thinsp;25%\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;388)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25% \u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50%\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcute crescent\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSubacute crescent\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eChronic crescent\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208/180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20/34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0224\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94/86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67/61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67/67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.9078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (9\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11\u0026ndash;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (10\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (10-19.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal duration (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (3-142.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.5 (8.75\u0026ndash;315)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (1\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (9-180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (13.75\u0026ndash;472.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUTP (mg/mmol)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.5 (59.85\u0026ndash;222.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177.9 (93.45\u0026ndash;372.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e144.3 (83.7-286.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e137 (75.39\u0026ndash;290.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80.31 (49.10-149.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUNAG (U/g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.420 (5.725\u0026ndash;13.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.70 (8.06\u0026ndash;20.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.865 (5.688\u0026ndash;15.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.21 (7.09\u0026ndash;16.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.77 (5.495\u0026ndash;11.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.155 (3.333\u0026ndash;4.968)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.255 (4.313\u0026ndash;6.220)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.225 (3.293\u0026ndash;5.238)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.36 (3.485\u0026ndash;5.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.24 (3.41\u0026ndash;5.083)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.8272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR (mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127.3 (106.2-145.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118.1 (89.1-134.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0062\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131 (107.6-147.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e123.8 (97.2-140.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e122.0 (100.9-142.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0147\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTI injury rate (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e233 (60.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (92.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (46.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e107 (83.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e93 (69.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal TI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute TI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic TI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eUTP: urinary total protein; UNAG: urinary N-acetyl-beta-D-glucosaminidase; BUN: blood urea nitrogen; eGFR: estimated glomerular filtration rate; TI: tubulointerstitial\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eComparison of laboratory indicators and pathological parameters between groups with different proportions of crescent\u003c/h3\u003e\n\u003cp\u003eCompared with crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group, the patients in 25% \u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group had higher urinary occult blood, UTP, UNAG, and blood urea levels, and had lower eGFR (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA-E). Compared with crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group, the rate of tubulointerstitial injury and acute tubulointerstitial injury score increased significantly in 25% \u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG-H). There was no difference in percentage of endocapillary proliferation and chronic tubulointerstitial injury score between two groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eI).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of laboratory indicators and pathological parameters among groups with different types of crescents\u003c/h2\u003e \u003cp\u003eThe formation and evolution of the crescent is a progressive process. We divided all patients into three groups: acute crescent group, subacute crescent group, and chronic crescent group according to the components of the crescents. Compared with acute crescent group, the patients in subacute crescent group had higher percentage of crescent, rate of tubulointerstitial injury, acute tubulointerstitial injury score and chronic tubulointerstitial injury score, but had lower percentage of endocapillary proliferation and eGFR. There are no difference in UTP and UNAG between acute\u003c/p\u003e \u003cp\u003ecrescent group and subacute crescent group. Compared with acute crescent group and subacute crescent group, patients in chronic crescent group had lower UTP, UNAG, percentage of endocapillary proliferation and acute tubulointerstitial injury score. Compared with acute crescent group, rate of tubulointerstitial injury and chronic tubulointerstitial injury score increased significantly in the chronic crescent group. Compared with subacute crescent group, chronic crescent group had lower percentage of crescent, higher chronic tubulointerstitial injury score and similar eGFR level. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComparison of treatments among groups with different proportions and types of crescents in patients with grade Ⅲ IgAVN\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn total, 203 patients were treated with oral prednisone plus tripterysium glycosides, 117 patients were treated with oral prednisone, 57 patients were treated with oral prednisone plus kunxian capsule, 31 patients were treated with prednisone plus mycophenolate mofetil, 22 patients were treated with methylprednisolone pulse treatment, 12 patients were treated with prednisone plus cyclophosphamide. Compared with crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group, the proportions of patients treated with methylprednisolone pulse and prednisone plus cyclophosphamide increased significantly in 25%\u0026le; crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group. Compared with acute crescent and chronic crescent groups, the proportions of patients treated with methylprednisolone pulse and prednisone plus cyclophosphamide increased significantly in subacute crescent group. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows treatment after renal biopsy and outcomes of different groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatments and outcomes of 442 patients with grade Ⅲ IgAVN in the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrescent\u0026thinsp;\u0026lt;\u0026thinsp;25%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25% \u0026le; crescent\u0026thinsp;\u0026lt;\u0026thinsp;50%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcute crescent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSubacute crescent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eChronic crescent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0131\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrednisone/methylprednisolone (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrednisone\u0026thinsp;+\u0026thinsp;tripterysium glycosides (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179 (46.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57 (44.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e56 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrednisone\u0026thinsp;+\u0026thinsp;Kunxian capsule (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrednisone\u0026thinsp;+\u0026thinsp;mycophenolate mofetil (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e14 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethylprednisolone pulse treatment (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrednisone\u0026thinsp;+\u0026thinsp;cyclophosphamide (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0288\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0157\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e82 (53.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e41 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD (that is ESRD) (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of outcomes among groups with different proportions and types of crescents in patients with grade Ⅲ IgAVN\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe followed up the patients for more than one year. The results showed that compared with the crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group, the prognosis of patients in the 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group was worse, and the incidence of ESRD was significantly higher (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-B). The comparison results among groups with different crescent composition showed that compared with the acute crescent group, the prognosis of patients in subacute crescent group and chronic crescent group were worse, and the incidence of ESRD were significantly higher. The incidence of ESRD was no difference between subacute crescent group and chronic crescent group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC-D). Nobody developed ESRD in acute crescent group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe proportion of crescent varies from 0% \u0026lt;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% in grade Ⅲ IgAVN. In our study, patients with grade Ⅲ IgAVN were divided into two groups on the basis of crescent proportion: \u0026lt;25% and 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50%. our results show that patients in 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group had higher UTP, UNAG, BUN, rate of tubulointerstitial injury and acute tubulointerstitial injury score, and had lower eGFR. The research of Huang et al also showed that adult IgAVN patients with \u0026gt;\u0026thinsp;25% crescents had more-severe renal manifestations than patients with \u0026lt;\u0026thinsp;25% crescents[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In IgA nephropathy and lupus nephritis, the scores of crescents with a proportion\u0026thinsp;\u0026lt;\u0026thinsp;25% and 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% are different[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Diffuse endocapillary proliferation lesion is an independent pathogenic factor of nephrotic-range proteinuria in IgAVN[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003ewas no difference in percentage of endocapillary proliferation between two groups in this study, suggesting that crescents are an independent predictor of increased proteinuria. Although with similar renal duration, with the increase of the proportion of crescents in grade Ⅲ IgAVN, the rate of tubulointerstitial injury increases and renal function declines in our study. The above studies suggest that IgAVN patients with 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% have more severe renal damage.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo further clarify the influence of the crescent on the laboratory indicators in grade Ⅲ IgAVN, we divided patients into acute crescent group, subacute crescent group and chronic crescent group according to the crescent type. Our results showed that patients subacute crescent group had longer renal duration, higher percentage of crescent, higher acute and chronic tubulointerstitial injury scores, but had lower percentage of endocapillary proliferation and eGFR. There was no difference in UTP between acute crescent group and subacute crescent group. Similar UTP level may result from increased percentage of crescents, but with decreased percentage of endocapillary proliferation. Both glomerular crescent and endocapillary proliferation lesions are the main influencing factors of proteinuria. Although cellular crescents and fibrocellular crescents are uniformly scored and given the same meaning in lupus nephritis and IgA nephropathy[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Fibrocelluar crescent formation mean rupture of the Bowman's capsule and glomerular injury involves tubulointerstitium, and cytotoxic CD8\u003csup\u003e+\u003c/sup\u003e T cells from interstitium migration into glomerulus, resulting in glomerular tuft and podocytes futher injury[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Compared with acute crescent group, eGFR was decreased in subacute crescent group and chronic crescent group, and there was no difference in eGFR between subacute crescent group and chronic crescent group. Above results suggest that different crescent type have distinct clinicopathological and laboratory characteristics and should be treat differently in\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003egrade Ⅲ IgAVN.\u003c/p\u003e \u003cp\u003eThe utility of crescents as a predictor of renal outcome in IgAVN was long-debated. Crescents were related with poor prognosis in some studies[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], but it was not confirmed by others in IgAVN[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our results showed that compared with the crescent\u0026thinsp;\u0026lt;\u0026thinsp;25% group, the prognosis of patients in the 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% group was worse and the incidence of ESRD was significantly higher despite undergoing intensive treatment. Inconsistent results may be related to sample size, patient population, indications for renal biopsy and different crescent types. Similar situation occurs in IgA nephropathy[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Crescents were relatively rare in IgA nephropathy and were not used as a parameter in the Oxford classification until its recent update. Two recent systematic review and meta-analysis showed that significantly increased risks of kidney outcomes were observed with a crescent proportion\u0026thinsp;\u0026gt;\u0026thinsp;10% and \u0026gt;\u0026thinsp;25%, and proportion\u0026thinsp;\u0026gt;\u0026thinsp;25% also displayed an elevated risk of ESRD in IgA nephropathy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The study of Du Y et al showed that crescents\u0026thinsp;\u0026ge;\u0026thinsp;25% was an independent risk factor for \u0026ge;\u0026thinsp;50% reduction in eGFR or ESKD in treated and untreated IgA nephropathy patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCellular crescents can dissipate after active treatment, while fibrocellular crescents may retain varying degrees of fibers, resulting in fibrous crescents or adhesions despite active treatment. The appearance of fibrocelluar crescent indicates the progression of the disease, involvement of renal tubulointerstitium. Our reslults showed that compared with the acute crescent group, the prognosis of patients in subacute crescent group and chronic crescent group was worse, and the incidence of ESRD was significantly higher. The incidence of ESRD was no difference between subacute crescent group and chronic crescent group, and no patient cccured ESRD in acute crescent group in our study.\u003c/p\u003e \u003cp\u003eIn conclusion, IgAVN patients with 25%\u0026le;crescent\u0026thinsp;\u0026lt;\u0026thinsp;50% have more severe renal damage and worse outcomes than patients with \u0026lt;\u0026thinsp;25% crescent. Therefore, pathological grade Ⅲ of IgVAN should be further refined. The appearance of fibrocelluar crescent indicates the progression of the disease, involvement of renal tubulointerstitium and an increase of incidence of ESRD. Cellular crescent, fibrocellular crescent and fibrous crescent should be separately counted to better reflect their value in guiding treatment and predicting prognosis in pathological diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e Ethical review committee of the First Affiliated Hospital of Henan University of Chinese Medicine approved the study with number 2023HL-512-01 and considering the retrospective review of charts, consent from the study participants was waived. The study followed ethical principles of declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Sources\u003c/h2\u003e \u003cp\u003eThis work was supported by Joint Fund Project of Science and Technology Research and Development Plan of Henan Province (232301420090), and The Scientific and Technological Innovation Guidance Plan for the Medical and Health Field of Zhengzhou City (2025YLZDJH316)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXQ Y and XQ R proposed the initial concept and contributed to the first draft; QS Z were responsible for analysis and interpretation of the data; YL Y were responsible for the collection the data; Y D and X Z reviewed and provided critical feedback on manuscript drafts. All authors approved the final version of the manuscrip.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVivarelli M, Samuel S, Coppo R, Barratt J, Bonilla-Felix M, Haffner D, et al. IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis. Pediatr Nephrol. 2024;40(2):533\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCounahan RWM, White RH, Heaton JM, Meadow SRBN, Swetschin H, Cameron JS, Chantler C. Prognosis of Henoch-Schonlein nephritis in children. Br Med J. 1977;2:11\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas M, Rastaldi MP, Fervenza FC. Histologic classification of glomerular diseases: clinicopathologic correlations, limitations exposed by validation studies, and suggestions for modification. Kidney Int. 2014;85(4):779\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarbour SJ, Coppo R, Er L, Pillebout E, Russo ML, Alpers CE, et al. Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis. Clin J Am Soc Nephrol. 2024;19(4):438\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu F, Wang C, Wang R, Wang W, Li M. Henoch-schonlein purpura nephritis with renal interstitial lesions. Open Med. 2018;13(1):597\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang M, Wang R, He X, Zhang P, Kuang Q, Yao J et al. Using MEST-C Scores and the International Study of Kidney Disease in Children Classification to Predict Outcomes of Henoch\u0026ndash;Sch\u0026ouml;nlein Purpura Nephritis in Children. Front Pead. 2021;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao Y, Shen T, Li Y, Shuai L, Chen Q, Mo S et al. A retrospective study on the characteristics of renal pathological grades in HSPN children with mild to moderate proteinuria. Front Pead. 2022;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXi L, Sun Y, Chen Y, Yang X, Su H, Ren X. Clinicopathological features and prognosis of IgA vasculitis nephritis with nephrotic-range proteinuria in children. Pediatr Nephrol. 2024;39(11):3241\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91(5):1014\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBajema IM, Wilhelmus S, Alpers CE, Bruijn JA, Colvin RB, Cook HT, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93(4):789\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas M, Seshan SV, Barisoni L, Amann K, Bajema IM, Becker JU, et al. Consensus definitions for glomerular lesions by light and electron microscopy: recommendations from a working group of the Renal Pathology Society. Kidney Int. 2020;98(5):1120\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR C A, D J N-P QS, H, Y LJJASN. Modulators crescentic glomerulonephritis. 1996;7(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurt-Ş\u0026uuml;k\u0026uuml;r ED, Sekar T, Tullus K. Biopsy-proven Henoch-Sch\u0026ouml;nlein purpura nephritis: a single center experience. Pediatr Nephrol. 2020;36(5):1207\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang X, Wu J, Wu X-m, Hao Y-x, Zeng C-h, Liu Z-h et al. Significance of histological crescent formation in patients with IgA vasculitis (Henoch-Sch\u0026ouml;nlein purpura)-related nephritis: a cohort in the adult Chinese population. BMC Nephrol. 2018;19(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X-q, Huang Y-j, Zhai W-s, Ren X-q, Guo Q-y, Zhang X, et al. Correlation between endocapillary proliferative and nephrotic-range proteinuria in children with Henoch-Sch\u0026ouml;nlein purpura nephritis. Pediatr Nephrol. 2018;34(4):663\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen A, Lee K, D\u0026rsquo;Agati VD, Wei C, Fu J, Guan T-J, et al. Bowman\u0026rsquo;s capsule provides a protective niche for podocytes from cytotoxic CD8\u0026thinsp;+\u0026thinsp;T cells. J Clin Invest. 2018;128(8):3413\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitching AR, Alikhan MA. CD8\u0026thinsp;+\u0026thinsp;cells and glomerular crescent formation: outside-in as well as inside-out. J Clin Invest. 2018;128(8):3231\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR H W ARG, C RA. CJL. Long-term follow-up of childhood Henoch-Sch\u0026ouml;nlein nephritis. 1992;339(8788).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu L, Zhang H, Wu Y. Association between different proportions of crescents and the progression of IgA nephropathy (IgAN): a systematic review and meta-analysis. BMC Nephrol. 2024;25(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKe X, Lili Z, Jie D, Suxia W, Baige S, Huijie X et al. Value of the Oxford classification of IgA nephropathy in children with Henoch-Sch\u0026ouml;nlein. purpura nephritis. 2017;31(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiaohan H, Lili M, Pingping R, Hongya W, Liangliang C, Haidongqin H et al. Updated Oxford classification and the international study of kidney disease in children classification: application in predicting outcome of Henoch-Sch\u0026ouml;nlein. purpura nephritis. 2019;14(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCattran DC, Coppo R, Cook HT, Feehally J, Roberts ISD, Troyanov S, et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int. 2009;76(5):534\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuko S, Koichi N, Taketsugu H, Hironobu M, Hiroko T, Yuya H et al. Validity Oxf Classif IgA Nephrop Child. 2011;27(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIan S, D RJCONH. Oxford classification of immunoglobulin A nephropathy: an update. 2013;22(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZang Z, Fang K, Ma N, Zhang Y, Shu Y, Li Z. Association between different proportions of crescents and adverse renal outcomes in immunoglobulin a nephropathy: a systematic review and meta-analysis. Ren Fail. 2025;47(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu Y, Chen S, Wang F, Zhang P, Liu M, Liu C et al. The Significance of Crescents on the Clinical Features and Outcomes of Primary Immunoglobin A Nephropathy. Front Med. 2022;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"IgA vasculitis nephritis, Crescent, Clinicopathology, Outcome","lastPublishedDoi":"10.21203/rs.3.rs-9134664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9134664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCrescent is a key pathological factor affecting the treatment in IgA vasculitis nephritis (IgAVN). The proportion of the crescent from 0 to 50% is broad in grade Ⅲ IgAVN. The present study aimed to analyze the clinicopathological features and outcomes of different proportions and types of crescent in grade Ⅲ IgAVN patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e From January 2020 to December 2024, 442 patients with grade Ⅲ IgAVN were enrolled in this retrospective study. The patients were divided into two groups on the basis of crescent proportion: \u0026lt; 25% and 25%≤crescent\u0026lt;50%. According to the crescent type, the patients were divided into three groups: acute, subacute and chronic crescent groups. The clinicopathological features and outcome were compared among groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Compared with crescent \u0026lt;25% group，urinary occult blood, proteinuria, urinary N-acetyl-beta-D-glucosaminidase (NAG), blood urea nitrogen (BUN), tubulointerstium injury rate and tubulointerstium injury scores all increased significantly, and estimated glomerular filtration rate (eGFR) decreased siginificantly in 25%≤crescent\u0026lt;50% group. Compared with acute crescent group, percentage of crescent, tubulointerstium injury rate and scores increased, eGFR and percentage of endocapillary proliferation decreased in subacute group, but proteinuria, urinary NAG and BUN were no difference between acute and subacute groups. Compared with acute and subacute groups, proteinuria in the chronic crescent group decreased significantly and chronic tubulointerstium score increased significantly. Follow up for 1 to 4 years, patients with 25%≤crescent\u0026lt;50% had higher incidence of end-stage renal disease (ESRD) than crescent\u0026lt;25% group, and patients in subacute and chronic crescent groups had higher incidence of ESRD than acute crescent group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Different proportions and types of crescent in patients with grade Ⅲ IgAVN had different clinicopathological features and outcomes. It is necessary to refine and score the proportion and type of crescents in pathological diagnosis of IgAVN patients.\u003c/p\u003e","manuscriptTitle":"Clinicopathological features and outcomes of different proportions and types of crescent in patients with grade Ⅲ IgA vasculitis nephritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-10 06:34:26","doi":"10.21203/rs.3.rs-9134664/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c00cd36-1472-4f79-adc4-8af310f167e2","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-10T07:57:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 06:34:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9134664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9134664","identity":"rs-9134664","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}