Clinicopathological Characteristics and Outcomes of Diffuse Crescentic Glomerulonephritis - A Single Center Experience from Southern India

• Published in: Journal of clinical and diagnostic research Vol. 11; no. 9; pp. OC21 - OC24
• Main Authors: Nagaraju, Shankar Prasad, Laxminarayana, Sindhura Lakshmi Koulmane, Kosuru, Srinivas, Parthasarathy, Rajeevalochana, Attur, Ravindra Prabhu, Rangaswamy, Dharshan, Matteti, Uday Venkat, Guddattu, Vasudeva
• Format: Journal Article
• Language: English
• Published: India JCDR Research and Publications (P) Limited 01.09.2017; JCDR Research and Publications Private Limited
• Subjects: anti-gbm disease; immune-complex glomerulonephritis; Nephrology Section; pauci-immune glomerulonephritis; Pauci-immune glomerulonephritis; Anti-GBM disease; Immune-complex glomerulonephritis
• ISSN: 2249-782X; 0973-709X
• DOI: 10.7860/JCDR/2017/28307.10621

Diffuse Crescentic glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure and has grave prognosis. There is significant regional and temporal variation in aetiology, prevalence and prognosis of diffuse crescentic glomerulonephritis (CrGN) with limited data available in adult Indian population. This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population. In this retrospective study, clinical records of all adults (>18 years) over a 5-year period (2010-2014) with a histopathological diagnosis of diffuse CrGN (>50% crescents) were reviewed. Clinical, serological, biochemical and histopathological data were collected. Follow-up data at six months including renal outcome and mortality were studied. Data was analysed using SPSS version 15. There were 29 cases of diffuse CrGN accounting for an incidence of 2.9% among 1016 non-transplant kidney biopsies. The most common cause was pauci-immune crescentic GN. The median creatinine at admission was 7.2 mg/dl {(interquartile range (IR) 3.3 - 10.4)} and 75.9% of patients required haemodialysis at admission. Complete/partial recovery was seen in 34.5%. At the end of six months 31% were dialysis dependent and the mortality was 27.6%. On univariate analysis, the significant predictors of renal loss and mortality were oliguria (p=0.02), requirement of haemodialysis and serum creatinine (p=0.001) at admission (>5.5mg/dl) (p=0.003). Histopathological features did not influence the outcome in our study. In our cohort, the most common cause for diffuse CrGN is pauci-immune CrGN. Diffuse CrGN carries a poor prognosis. Patients with pauci-immune and AntiGBM disease have worst prognosis compared to immune complex CrGN. The presence of oliguria, high serum creatinine and requirement of haemodialysis at admission are associated with poor outcomes.