Clinicopathological Spectrum and Outcome of Crescentic Glomerulonephritis: A Retrospective Study from North-East India
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Keywords
crescentic glomerulonephritis, pauci-immune glomerulonephritis, antineutrophil cytoplasmic antibodies–associated vasculitis, lupus nephritis, Ig A nephropathy
Abstract
Crescentic glomerulonephritis (CrGN) is characterized by the presence of crescents in more than 50% of glomeruli. This study aims to identify the etiology and clinicopathological features and outcomes of CrGN. In this observational study, 80 biopsy-proven CrGN were included. Patients’ demographic profile, clinical parameters, treatments, and outcomes were collected and analyzed. The mean age in our study population was 40.86 ± 16.5 years. Type II CrGN was the most common type of CrGN. Female predominance was observed in type I and type II CrGN. The highest percentage of glomeruli with crescents was seen in type I (87 ± 15.2%, P = 0.04), followed by type III and type II. At the last follow-up, mean estimated glomerular filtration rate was 25.8 ± 11.41 mL/min/1.73 m2 and was significantly lower in type I CrGN (11.6 ± 4.8 mL/min/1.73 m2 P = 0.001). The overall 5-year renal survival rate was 55% and was highest in type II (69.4%), followed by type III and type I (27.3%) CrGN (P = 0.0299). In our study, oliguria at the time of presentation, percentage of crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes. In conclusion, CrGN was seen in 5.7% of kidney biopsies in our study. Type II CrGN was the most common type of CrGN followed by type III CrGN. Renal survival was poor in type I CrGN patients compared to type II and type III CrGN. Also, oliguria, crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes.
References
2. Jennette JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003;63:1164–77. 10.1046/j.1523-1755.2003.00843.x
3. Tipping PG, Kitching AR, Cunningham MA, Holdsworth SR. Immunopathogenesis of crescentic glomerulonephritis. Curr Opin Nephrol Hhypertens. 1999;8(3):281–6. 10.1097/00041552-199905000-00002
4. Couser WG. Rapidly progressive glomerulonephritis: Classification, pathogenetic mechanisms, and therapy. Am J Kidney Dis. 1988;11(6):449–64. 10.1016/S0272-6386(88)80079-9
5. Sasatomi Y, Kiyoshi Y, Takabeyashi S. A clinical and pathological study on the characteristics and factors influencing the prognosis of crescentic glomerulonephritis using a cluster analysis. Pathol Int. 1999;49(9):781–5. 10.1046/j.1440-1827.1999.00943.x
6. Oudah N, Al Duhailib Z, Alsaad K, Qurashi S, Ghamdi G, Flaiw A, et al. Glomerulonephritis with crescents among adult Saudi patients outcome and its predictors. Clin Exp Med. 2012;12(2):121–5. 10.1007/s10238-011-0147-4
7. Falk RJ. ANCA-associated renal disease. Kidney Int. 1990;38(5):998–1010. 10.1038/ki.1990.304
8. Dewan D, Gulati S, Sharma RK, Prasad N, Jain M, Gupta A, et al. Clinical spectrum and outcome of crescentic glomerulonephritis in children in developing countries. Pediatr Nephrol. 2008;23(3):389–94. 10.1007/s00467-007-0647-3
9. Baldwin DS, Neugarten J, Feiner HD, Gluck M, Spinowitz B. The existence of a protracted course in crescentic glomerulonephritis. Kidney Int. 1987;31(3):790–4. 10.1038/ki.1987.67
10. Jennette JC, Thomas DB. Crescentic glomerulonephritis. Nephrol Dial Transplant. 2001;16(suppl_6):80–2. 10.1093/ndt/16.suppl_6.80
11. Levy JB, Turner AN, Rees AJ, Pusey CD. Long-term outcome of anti–glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression. Ann Int Med. 2001;134(11):1033–42. 10.7326/0003-4819-134-11-200106050-00009
12. Hogan SL, Nachman PH, Wilkman AS, Jennette JC, Falk RJ. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. 1996;7(1):23–32. 10.1681/ASN.V7123
13. Choudhury TA, Singh RG, Singh S, Singh TB, Rathore SS. Clinicopathologic spectrum of crescentic glomerulonephritis: A hospital-based study. Saudi J Kidney Dis Transplant. 2014;25(3):689. 10.4103/1319-2442.132241
14. Gupta R, Singh L, Sharma A, Bagga A, Agarwal SK, Dinda AK. Crescentic glomerulonephritis: A clinical and histomorphological analysis of 46 cases. Indian J Pathol Microbiol. 2011;54(3):497. 10.4103/0377-4929.85081
15. Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro III AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150: 604–12. 10.7326/0003-4819-150-9-200905050-00006
16. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2:139–274.
17. Rampelli SK, Rajesh NG, Srinivas BH, Kumar KH, Swaminathan RP, Priyamvada PS. Clinical spectrum and outcomes of crescentic glomerulonephritis: A single center experience. Indian J Nephrol. 2016;26(4):252. 10.4103/0971-4065.158574
18. Koyama A, Yamagata K, Makino H, Arimura Y, Wada T, Nitta K, et al. A nationwide survey of rapidly progressive glomerulonephritis in Japan: Etiology, prognosis and treatment diversity. Clin Exp Nephrol. 2009;13(6):633–50. 10.1007/s10157-009-0201-7
19. Quiroga B, Vega A, Rivera F, López-Gómez JM, Spanish registry of glomerulonephritis. crescentic glomerulonephritis: Data from the Spanish Glomerulonephritis Registry. Int Med J. 2015;45(5):557–62. 10.1111/imj.12725
20. Alexander S, Yusuf S, Rajan G, John EE, Roy S, Annamalai VC, et al. Crescentic glomerulonephritis: What’s different in South Asia? A single center observational cohort study. Wellcome Open Research. 2020;5. 10.12688/wellcomeopenres.16071.1
21. Chen S, Tang Z, Xiang H, Li X, Chen H, Zhang H, et al. Etiology and outcome of crescentic glomerulonephritis from a single center in China: A 10-year review. Am J Kidney Dis. 2016;67(3):376–83. 10.1053/j.ajkd.2015.07.034
22. Al-Hussain T, Asiri S, Amer S, Al Mana H, Akhtar M. Patterns of glomerulonephritis with crescents: Experience at a tertiary medical center in Saudi Arabia. Saudi J Kidney Dis Transplant. 2017;28(3):532. 10.4103/1319-2442.206448
23. Wu T, Peng J, Meng T, Liu Q, Ao X, Lin W, et al. Clinicopathological features and prognostic analysis of 49 cases with crescentic glomerulonephritis. Exp Ther Med. 2019;18(5):3984–90. 10.3892/etm.2019.8023
24. Lin W, Chen M, Cui Z, Zhao MH. The immunopathological spectrum of crescentic glomerulonephritis: A survey of 106 patients in a single Chinese center. Nephron Clin Pract. 2010;116(1):c65–74. 10.3892/etm.2019.8023
25. Levy JB, Hammad T, Coulthart A, Dougan T, Pusey CD. Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int. 2004;66:1535–40. 10.1111/j.1523-1755.2004.00917.x
26. López-Gómez JM, Rivera F. Renal biopsy findings in acute renal failure in the cohort of patients in the Spanish Registry of Glomerulonephritis. Clin J Am Soc Nephrol. 2008;3(3):674–81. 10.2215/CJN.04441007
27. Han F, Chen L, Le J, Choong P, Xu Y, Wang H, et al. The clinicopathologic spectrum of rapidly progressive glomerulonephritis based on glomerular immune deposition and antineutrophil cytoplasmic antibody. Appl ImmunohistochemMol Morphol. 2015;23(10):704–10. 10.1097/PAI.0000000000000134
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Mastakim Ahmad Mazumder, DM Nephrology, Nephrology, Fortis Hospital, Okhla, New Delhi, India.
Department of Nephrology, Fortis Hospital, Okhla, New Delhi, India.