Clinicopathologic spectrum of crescentic glomerulonephritis: A hospital-based study

Abstract

Recent data regarding the clinical and histopathologic spectrum of crescentic glomerulonephritis (CSGN) among the Indian adult population is unknown. Our aim is to study the clinicopathological features and outcome of CSGN. It is a retrospective observational study from a tertiary care hospital in India over 3.5 years. Biopsy-proven cases of CSGN (i.e., >50% crescents in glomeruli) were included in the study. Cases with insufficient data were excluded. There were 34 cases of CSGN, accounting for an incidence of 5.5% among kidney biopsies. The mean age was 32.2 ± 16.09 years, with male to female ratio of 12:22. Clinical presentations of CSGN include rapidly progressive glomerulonephritis in 23 (67.7%), chronic renal failure (CRF) in seven (20.5%), nephrotic syndrome in two (5.8%) and acute nephritic syndrome in two (5.8%) patients. The immunological profile of CSGN showed MPO-ANCA in nine (26.4%), PR3-ANCA in one (2.9%), both PR3 and MPO-ANCA in one (2.9%), anti-GBM antibody in five (14.7%) and lupus nephritis in six (17.6%) patients. All the three antibodies were present in one patient. The percentage of glomeruli showing crescents were 100% in nine (26.4%) and ≥80% in seven (20.5%) patients. Type of crescents seen were cellular in 11 (32.3%) and fibrocellular in 22 (64.7%) patients and fibrous in one (2.9%) patient. Interstitial fibrosis was found in seven (20.5%) patients. Dialysis dependency was seen in 11 (32.3%) patients. After 3 months of follow-up, mortality was seen in three (8.8%), remission in eight (23.5%), CRF in 15 (44.1%) and ESRD in five (14.7%) patients. CSGN carries a poor prognosis. The disorder may have an insidious onset and a slowly progressive course. ANCA, anti-GBM-antibody and anti-dsDNA can coexist in CSGN.

Anti-glomerular basement membrane crescentic glomerulonephritis: A report from India and review of literature

“…[9] Our study and earlier reports from India suggest that these patients are diagnosed late resulting in a poor renal outcome. [14] The poor response to therapy may be attributed to the presence of rapidly progressive glomerulonephritis in all our patients who were dialysis-dependent at the time of presentation. Alchi et al .…”

“…[31011] An incidence of 6–16% has been reported from China and Japan. [12131415] Reports from India are variable. A study from North-East India including 34 patients of CrGN over a period of 3.5 years reported an incidence of 14.7%.…”

“…A study from North-East India including 34 patients of CrGN over a period of 3.5 years reported an incidence of 14.7%. [14] However, another study from North India found no case of anti-GBM nephritis over a 2 years study of 46 patients of CrGN. [16] We found a prevalence of 5% for anti-GBM nephritis among 215 patients diagnosed as CrGN on renal biopsy.…”

Study of Etiology and Clinical Assessment of Crescentic Glomerulonephritis

“…Even though the age distribution of patients was similar to previous studies, comparison with the existing series might have limitations in view of the different etiologic spectrum. [9][10][11] The histological parameters were comparable in the two groups except for the higher proportion of sclerosed glomeruli in ICGN. This might be secondary to the high proportion of patients with IgA nephropathy and lupus nephritis, which follows a more indolent course [12] .…”

“…The most common etiology of ICGN in the current study was IgA nephropathy followed by lupus and PIGN. A few studies from Asia have reported ICGN as the predominant etiology in adults [10][11][12][13] .…”