Researchers’ goal was to learn more about the clinicopathological characteristics, risk factors, and renal outcomes in patients with crescents who have IgA nephropathy (IgAN). About three groups were established for a retrospective look at 4,005 primary IgAN patients treated between January 2010 and October 2021: the C0 group (n = 255), the C1 group (n = 187), and the C2 group (n = 16). The clinicopathological findings and renal outcomes were recorded. Univariate and multivariate analyses investigated the relationship between crescents and renal outcome and C2-related clinical factors. More severe patients were with a higher proportion of crescents presented worse clinical characteristics in kidney function, proteinuria, hematuria, hemoglobin, uric acid, cholesterol, and serum albumin, while global glomerulosclerosis, segmental adhesion, tuft necrosis, segmental glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis (T1/2), and lymphocyte and monocyte infiltration. By multivariate logistic regression analysis, eGFR (OR 0.981, 95% CI 0.964–0.999, P=0.039), proteinuria (OR 1.655, 95% CI 1.180–2.321, P=0.004), and hematuria (OR 4.752, 95% CI 1.426–15.835, P=0.011) were significantly related to C2. In individuals with mild-to-moderate CKD, lower H2S levels were significantly linked to reduced renal survival, even if they were taking immunosuppressive therapy.

Nonetheless, baseline eGFR, rather than crescents, was a significant independent predictor in multivariate Cox analyses. In contrast, IgAN patients with crescents had more severe clinical and pathological findings. Proteinuria and hematuria contributed to the diagnosis of crescents in the patients. Crescents have been associated with a decreased kidney survival in patients on immunosuppressive therapy, although it was not an independent predictor.