Persistent Hematuria Research Articles

Alport syndrome: our knowledge update

Alport syndrome is a progressive multisystem disease associated with variants in genes COL4A3, COL4A4, COL4A5.The syndrome is an important genetic cause of kidney failure, including women with X-linked disease. Given the unfavorable natural history of Alport nephropathy and benefit from early treatment with angiotensin-converting enzyme inhibition, it is necessary to change our diagnostic approach in patients with persistent glomerular hematuria and management of patients with Alport syndrome. This review presents the ethiology, pathogenesis, genotype and phenotype heterogeneity of the syndrome and expert clinical practice recommendations to enhancing early diagnosis and achieving optimal outcomes in Alport syndrome.

Rituximab for refractory necrotizing scleritis and peripheral ulcerative keratitis secondary to antineutrophil cytoplasmic antibody-negative granulomatosis with polyangiitis

A 52-year-old woman was diagnosed with bilateral necrotizing scleritis (NS) and peripheral ulcerative keratitis secondary to the antineutrophil cytoplasmic antibody (ANCA)-negative granulomatosis with polyangiitis (GPA) as evidenced by increased erythrocyte sedimentation rate, bilateral multiple cavitation lung nodules, and persistent microscopic hematuria. Infective workup and autoimmune tests were negative including the ANCA test. She received multiple courses of high dose intravenous methylprednisolone, intravenous cyclophosphamide, and oral methotrexate. Multiple tectonic patching operations were performed. Despite all the treatment, the disease continued to progress. Eventually, few doses of rituximab were given and the disease was stable for at least a year without any reactivation.

Persistent Isolated Hematuria in a Japanese Woman.

A 43-year-old Japanese woman, with a family history of hematuria, underwent a kidney biopsy because of persistent hematuria without proteinuria, with serum creatinine of 0.55 mg/dl. Light microscopy revealed minor glomerular abnormalities. Electron microscopy predominantly showed thinning of the glomerular basement membrane (GBM); thickening and lamination were observed in small portions of the GBM (Figure 1A). Atypical Alport syndrome (AS) was suspected. Type IV collagen staining revealed weak α5(IV) expression with enhanced expression of α2(IV) in segmental lesions, consistent with AS (Figure 1, B and C). This case was presumed to be autosomal dominant AS (ADAS), because of the family history and preserved α5(IV) expression in the Bowman’s capsule, which indicate the mutation of COL4A3 or COL4A4 (Figure 1C) (1). Diagnosis of typical AS, namely, X-linked AS in males and autosomal recessive AS, is straightforward, and often made in childhood. In contrast, ADAS is usually suspected in adults because …

Open simple prostatectomy and robotic simple prostatectomy for large benign prostatic hyperplasia: Comparison of safety and efficacy

BackgroundTo compare the safety and efficacy of open simple prostatectomy (OSP) and robotic simple prostatectomy (RSP) for the treatment of large benign prostatic hyperplasia (BPH).Materials and methodsWe retrospectively reviewed the medical records of 52 patients who underwent OSP (n = 23) and RSP (n = 29) between January 2005 and March 2019 at a single institution. The preoperative status of the patients, complications related to surgery, and the functional outcomes of the surgery were analyzed.ResultsThere were no significant differences in the preoperative total prostate volume, transitional volume, prostate-specific antigen value, and age between the two groups. Postoperative improvements in the International Prostate Symptom Score, maximum urinary flow rate, and postvoid residual were significant and similar for both groups. There were no significant differences between the two groups regarding surgery duration and resected prostate volume. The majority of patients in both groups had the urethral Foley catheter removed within the planned 10 day postoperative period, with the exception of two patients in the OSP group who had prolonged indwelling Foley catheter placement because of persistent hematuria. Postoperative hematocrit changes were significantly lower in the RSP group (RSP: 7.8 ± 4.1%, OSP: 14.2 ± 4.9%, P < 0.001). Seven patients (30.4%) who underwent OSP and two patients (6.9%) who underwent RSP were transfused because of significant intraoperative bleeding. Two patients from the RSP group who received transfusion comprised the first two cases that underwent RSP treatment. During the follow-up period, two patients (one patient in the OSP group and one patient in the RSP group) underwent transurethral incision of the bladder neck for bladder neck contracture.ConclusionBoth OSP and RSP can produce excellent outcomes after surgery. However, complications of bleeding are significantly less prevalent in RSP, suggesting that RSP can replace conventional OSP.

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Background: The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN. Methods: Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models. Results: Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87–2.00; p = .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40–2.50; p < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58–0.79; p < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR. Conclusions: Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.

Mild X-linked Alport syndrome due to the COL4A5 G624D variant originating in the Middle Ages is predominant in Central/East Europe and causes kidney failure in midlife

A study of 269 children enrolled into a National Registry for children with persistent glomerular hematuria identified 131 individuals with genetically confirmed X-linked Alport Syndrome. A single variant c.1871G>A p.Gly624Asp (G624D) in COL4A5 was predominant and accounted for 39% of X-linked Alport Syndrome in unrelated Polish families (44 of 113). To evaluate its origins, the genetic variation in a 2.79 Mb segment encompassing the COL4A5 locus on chromosome X was assessed. All G624D alleles were found on the same rare haplotype background, indicating a founder effect dating back to the 12-13th century. The phenotypic data of 131 children with X-linked Alport Syndrome and their 195 affected adult relatives revealed that the G624D variant was associated with a significantly milder clinical course in comparison to other pathogenic COL4A5 variants. Furthermore the clinical course of this genetically uniform cohort was milder than that observed in individuals with other COL4A5 missense mutations. In spite of the benign clinical manifestation throughout childhood and early adulthood, the G624D variant confers significant risk for both kidney failure and deafness in males, albeit 20-30 years later than that observed in individuals with other COL4A5 pathogenic variants (50% cumulative risk of starting dialysis at 54 years (95% confidence interval: 50-62) v. 26 years (95% confidence interval: 22-30)). Thus, males with G624D are candidates for existing and emerging therapies for Alport Syndrome.

Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study.

Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan.Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined.Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students.Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.

Clinicopathological profile and outcomes of infection-related glomerulonephritis in adults.

Infection-related glomerulonephritis (IRGN) is an example of immune-mediated glomerular injury, with changing profile over the years. We analyzed the clinicopathological profile of IRGN from a single center. Adult renal biopsies between July 2018 and January 2020 were screened, and biopsies with IRGN were included. The demographic, clinical, and laboratory data up to 6 months were analyzed. 27 patients were included, with 63% having evidence of current/recent infection, Staphylococcus and Streptococcus being most common (29.4%). The mean eGFR at presentation was 16.7mL/min/1.73m2, with crescents in 70.4% of cases. 59.3% required dialysis, and 40.7% received steroids. Complete recovery was seen in 84.6%, while 11.1% developed chronic kidney disease, and 3.7% progressed to end-stage renal disease. Persistent proteinuria, hematuria, and hypertension at 6 months were seen in 11.1, 7.4, and 3.7%, respectively. There was significant negative correlation between renal recovery and history of diabetes, interstitial fibrosis and tubular atrophy (IFTA), glomerulosclerosis, and IgA deposits. There was no significant impact of steroid use on outcome. IRGN can have an aggressive course in adults, with renal recovery continuing beyond 3 months. IFTA, glomerulosclerosis, IgA deposits, and history of DM are significant negative predictors of clinical outcome, and there is no proven benefit of steroids.

Renal calyceal diverticulum mimicking a large renal cyst-A case report

Renal calyceal diverticulum are outpouching from renal calyx or pelvis into the renal cortex lined by transitional cell epithelium. We report a case of 35 years old male with history of accidental fall from bike, who presented with persistent right loin pain and hematuria. CT Urogram showed multiple large right renal cysts (BOSNIAK II). Patient was planned laparoscopic renal cyst deroofing. Due to suspicion of calyceal diverticulum, an intraoperative Retrograde Pyelogram (RGP) was done which showed calyceal diverticulum. Laparoscopic calyceal diverticulotomy with closure of communication was done. If only a cyst deroofing was done considering the CT finding alone, it would have ended up in post-operative complication of urinoma which may require a re-surgery. This case report emphasizes the importance of anticipating calyceal diverticulum and intraoperative attempts in the form of doing RGP to identify calyceal diverticulum which mimic renal cyst regardless of CT finding in suspected cases.&#x0D; Keywords: Calyceal diverticulum; large renal cyst; retrograde pyelogram; laparoscopic calyceal; Diverticulotomy.

Pelvic Pseudoaneurysm as a Cause of Severe Hematuria After Robotic-assisted Radical Prostatectomy

To alert the medical society regarding that hematuria after radical prostatectomy can be caused by pelvic pseudoaneurysm. Case report of a 61-year-old male underwent extraperitoneal robotic-assisted radical prostatectomy. He was readmitted on the 15th POD due to gross hematuria with resolution after bladder irrigation. It returned on the 21st POD. The CT angiography evidenced the pseudoaneurysm of the left internal iliac artery. Selective embolization was effectively performed, with no additional bleeding or pelvic ischemia. Endovascular therapy is the preferred method of treatment. The pelvic pseudoaneurysm is a rare, but serious complication that can cause severe bleeding. In our experience, we had 3 cases of persistent hematuria caused by pelvic pseudoaneurysm after 1810 robotic-assisted radical prostatectomy.

The Management of Non-Dialysis-Dependent Chronic Kidney Disease in Primary Care.

Approximately 10% of adults in Germany have chronic kidney disease (CKD). The prevalence of CKD among patients being cared for by general practitioners is approximately 30%, and its prevalence in nursing homes is over 50%. An S3 guideline has been developed for the management of CKD in primary care. The guideline is based on publications retrieved by a systematic search of the literature for international guidelines published in the period 2013-2017, and additional searches on specific questions. It was created by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM) and consented with the German Societies of Nephrology and Internal Medicine (DGfN, DGIM) and patient representation. Upon the initial diagnosis of CKD (glomerular filtration rate [GFR] <60 mL/ min), the patient's blood pressure and urinary albumin-to-creatinine ratio (ACR) should be measured, and the urine should be examined for hematuria. Monitoring intervals are determined on an individual basis depending on the stage of disease and the patient's general state of health and personal preferences. Nephrological consultation should be obtained if the GFR is less than 30 mL/min, if CKD is initially diagnosed (GFR 30-59 mL/min) in the presence of persistent hematuria without any urological explanation or of albinuria in stage A2 or higher, if the patient has refractory hypertension requiring three or more antihypertensive drugs, or if the renal disease is rapidly progressive. The threshold for referring a patient should be kept low for persons under age 50; persons over age 70 should be referred only if warranted in consideration of their comorbidities and individual health goals. The main elements of the treatment of CKD are the treatment of hypertension and diabetes and the modification of lifestyle factors. An innovation from the primary care practioner's perspective is the assessment of albuminuria with the albumin-to-creatinine ratio.

Prognostic Value of Persistent Proteinuria and Hematuria After Induction Therapy in ANCA-Associated Vasculitides

Prognostic Value of Persistent Proteinuria and Hematuria After Induction Therapy in ANCA-Associated Vasculitides

Higher cardiovascular mortality in men with persistent dipstick hematuria.

We previously reported that dipstick hematuria (UH) was associated with higher all-cause mortality in men, but not in women. We extended the observation and examined the causes of death using repeated urinalysis in men. Subjects were those who participated the Tokutei-Kenshin between 2008 to 2015 in seven districts. Using National database of death certificate, we identified those who might have died and confirmed further with the collaborations of the regional National Health Insurance agency and public health nurses. Dipstick results of 1 + and higher were defined as hematuria. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazard analysis. We adjusted for age, body mass index, eGFR, proteinuria, comorbid condition (diabetes mellitus, hypertension, and dyslipidemia), past history (stroke, heart disease, and kidney disease), and lifestyle (smoking, drinking, walking, and exercise). A total of 170,119 men were studied and 70,350 (41.4% of the total) were re-examined next year. The prevalence of UH (-/-), UH (-/+), UH (±), and UH (+ /+) was 77.2% (N = 54,298), 14.0% (N = 9,838), 1.4% (N = 1014) and 7.4% (N = 5,200), respectively. We identified 1,162 deaths (1.7% of the total of the re-examined). The adjusted HR (95% CI) was 1.49 (1.22-1.81) for all-cause mortality and 1.83 (1.23-2.71) for cardiovascular death compared to those with UH (-/-), respectively. However, that for cancer mortality risk was not significant: 1.23 (0.92-1.64). In men, persistent dipstick hematuria is a significantly risk factor of all-cause mortality, in particular cardiovascular death among general screening participants.

Hematuria at dipstick on first versus second morning voiding: A screening for patients with persistent isolated hematuria?

BackgroundIn our clinical practice we observed that –differently from patients with defined glomerulopathies– children with persistent isolated microscopic hematuria (PImH) usually shows at dipstick on first compared with second morning voiding lower degree of hematuria. We hypothesized that comparison of hematuria degree between first and second morning voiding (dipstick comparison test) could help in selection of patients needing of specific investigations. In this study, we aimed preliminarily validating our hypothesis. MethodsTo define the risk of active glomerulopathies we used patients with defined glomerulopathies as cases. We prospectively enrolled 103 children during a one-year period. Sixty-nine of them had PImH, 16 microscopic/macroscopic hematuria (mMH), and 18 defined glomerulopathies.Inclusion criteria were: 1) persistent microscopic hematuria (≥1+ at dipstick) with or without defined glomerulopathy and/or previous episodes of macroscopic hematuria; 2) for the patients without defined glomerulopathy, having made regular biannual follow-up visits for at least 2 years in our department; 3) normal renal function and blood pressure at enrollment visit.We compared hematuria degree between first and second morning voiding. Possible findings were absence (NH), less degree (LH), similar degree (SH), and higher degree (HH) of hematuria in the first compared with second voiding. ResultsAt dipstick comparison test, 27.2% of patients presented NH, 44.7% LH, 28.1% SH, and none HH. NH showed specificity and PPV of 100% and significant area under receiver operating characteristic curve (AUROC = 0.66; 95%CI:0.55–0.78; p = 0.03) for absence of defined glomerulopathies. LH showed better sensitivity (76.9% Vs 33%) and NPV (78.9% Vs 24%) and lower specificity (88.2% Vs 100%) and PPV (87.0% Vs 100%) than NH for absence of defined glomerulopathies. Moreover, the LH showed a non-significant AUROC curve for presence of defined glomerulopathies. SH showed specificity of 80%, NPV of 91.9% and significant AUROC curve for presence of defined glomerulopathies (0.67; 95%CI:0.55–0.80; p = 0.009).The ROC curve analysis examining the delta of hematuria degree comparing first with second morning urine voiding showed a significant AUROC curve (AUROC = 0.78; 95%CI,0.68–0.89; p = 0.0002) with delta ≤ 1 showing the best sensitivity (80%) and specificity (66.7%) for defined glomerulopathies.None of the patients with defined glomerulopathies presented NH. Having SH presented relative risk for defined glomerulopathy of 5.1 (95%CI:1.9–13.6; p = 0.0007). Conversely, taken together NH and LH the RR was 0.2 (95%CI 0.1–0.5; p = 0.0007). InterpretationsThe dipstick on the first urine voiding underestimates the hematuria in about 70% of patients. The dipstick comparison test might easily screen patients with PImH and mMH needing of further investigations and treatment.

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

Purpose: To identify the incidence and predictive factors of infectious complications in a prophylactic-controlled cohort of men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) at a single institution. Materials and Methods: A retrospective review was performed on 539 patients who underwent TRUS-Bx between 2010-2015. All patients received prophylactic Sulfamethoxazole/Trimethoprim and Levofloxacin prior to the biopsy. Charlson Comorbidity Index (CCI) was calculated for each patient. The characteristics of patients with and without infectious complications were compared using Fisher exact tests and student’s t-test. Results: 539 biopsies were performed. Mean age was 64 years, PSA was 17, prostate volume was 41 mL, and CCI score was 3. A total of 7 (1.3%) infectious complications were reported 48-72 hours after biopsy, with 2 (0.4%) developing sepsis. Analysis indicated no significant differences in mean age (p=0.544), PSA (p=0.881), prostate volume (p=0.532), or CCI score (p=0.499) among patients who developed infection. Individual components of the CCI revealed no statistically significant differences. Additional complications following biopsy included: hematuria (8.3%), rectal bleeding (1.3%), urinary urgency (0.9%), and new onset erectile dysfunction (0.6%). Hematuria was associated with the development of infectious complications (OR=8.75, CI 1.895–40.400, p=0.0055). Conclusions: Our cohort of patients undergoing TRUS-Bx had a lower infectious rate compared to that reported by the AUA (1.1% vs 5-7%). Although this study has limited power, CCI was poorly predictive of infectious complications following TRUS-Bx. Persistent hematuria following biopsy was associated with infectious complications. The clinical importance of hematuria following TRUS-Bx, if any, needs to be further clarified.

Gross hematuria: A rare presentation of disseminated tuberculosis

Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria.12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.

Clinical Case: Successful Use of Repeated Superselective Arterial Embolization in Metastatic Prostate Cancer Complicated by Bleeding

Persistent hematuria, the source of which is a neoplasm of the prostate gland, is a potentially life threatening condition that exacerbates major therapeutic problems. The most common causes of severe hematuria are prostate cancer. Most often, severe recurrent prostatic bleeding occurs with untreated lesions and especially with hormone-refractory form of cancer. In many patients, bleeding cannot be completely controlled by conservative measures, such as routine hemostatic drugs, topical cold, urethral catheter drainage with permanent irrigation with sterile solutions, silver nitrate instillation, or endoscopic diathermy. Currently, the «gold standard» for the treatment of localized prostate cancer is radical prostatectomy. However, radical surgery is not always possible, despite the high efficiency, due to various circumstances, namely: age and due to this factor comorbidities that increase the risk of anesthesia. In this group of patients, it is advisable to use pelvic angiography with embolization, which proved to be a safe and effective method of controlling prostate bleeding. However, the analysis of the results of this technique is based on clinical cases and small, with a limited number of patients, studies. Despite this, selective arterial embolization has become the method of choice when conservative treatments are ineffective.

Retrospective Analysis of Clinical Outcomes in Patients with Immunoglobulin A Nephropathy and Persistent Hematuria Following Renin-Angiotensin System Blockade.

BackgroundRecent guidelines recommend that patients with immunoglobulin A nephropathy (IgAN) and proteinuria 0.5–1 g/d and >1 g/d be treated with long-term renin–angiotensin system blockade (RASB). This study investigated whether patients with IgAN and persistent hematuria, but without proteinuria, can benefit from RASB.Material/MethodsIgAN patients with persistent hematuria at four centers were recruited from January 2013 to December 2018. Patients were divided into those who did and did not receive long-term RASB. The primary outcome was the appearance of proteinuria, and the secondary outcomes were the decreased percentage of hematuria, rate of decline in estimated glomerular filtration rate (eGFR) and final blood pressure. The effects of RASB on these outcomes were assessed by multivariate Cox regression models and propensity score matching.ResultsOf the 110 eligible patients, 44 (40.0%) received RASB and 66 (60.0%) did not. Treated patients had higher diastolic pressure. The unadjusted primary outcome, the appearance of proteinuria, was significantly less frequent in individuals who were than who were not treated with RASB. Multivariate Cox regression showed that RASB reduced the risk of the primary outcome and the levels of hematuria. The rate of eGFR decline and final blood pressure did not differ in the two groups.ConclusionsRASB reduced the risk of proteinuria development and increased the remission of hematuria in patients with IgAN who presented with persistent hematuria alone. RASB, however, did not affect blood pressure in patients without hypertension and did not affect the rate of eGFR decline.

Renal survival and risk factors in IgA nephropathy with crescents.

The association between crescents and renal outcomes was inconsistent in a Chinese IgA nephropathy (IgAN) cohort, and limited research has investigated the prognosis of IgAN patients with crescents. Between January 2008 and January 2013, 169 consecutive IgAN patients with crescents in the Xijing Hospital, who were matched to IgAN patients without crescents at a 1:1 ratio by sex, age, eGFR, and proteinuria were reviewed. Combined events were defined by either a ≥ 50% reduction in eGFR or ESRD. All patients were followed for a mean of 49.9 ± 26.0months, and 41 (12.1%) patients had developed combined events. Five multivariate Cox regression models were created, and crescents was an independent risk factor for combined events. In model 5, crescents (HR = 2.216, 95% CI 1.040-4.345, P = 0.039) were notably associated with the risk of combined events after adjusting for age, sex, smoking, TA-P, persistent hematuria, and TA-MAP. Of the IgAN patients with crescents, 17.2% had developed combined events. In the baseline variables model, age, proteinuria, eGFR, E1, T1-T2, and RAAS had statistically significant associations with combined events in the multivariate Cox regression analyses. In the time varying variables model, TA-P, persistent hematuria, and TA-MAP were independent risk factors for combined events. We validated that the presence of crescents was an independent predictor of combined events in Chinese IgAN patients. Age, proteinuria, eGFR, E1, T1-T2, RAAS, TA-P, persistent hematuria, and TA-MAP were independent risk factors for combined events in IgAN patients with crescents.