An Observational Cohort Study of Clinicopathological Features and Outcomes of Crescentic Glomerulonephritis.

INTRODUCTION : Crescentic glomerulonephritis (CrGN) is a renal pathological entity manifested clinically as rapidly progressive glomerulonephritis (RPGN) in majority of the patients. Sometimes the clinical term RPGN and the pathological term CrGN are used interchangeably. It is a well defined condition occurring in a wide variety of primary glomerular disease and systemic conditions. Without treatment, CrGN rapidly progress to end stage renal disease within weeks to months. There is no consensus on how many glomeruli should have crescents to use the term crescentic GN. Most of the literatures have defined >50% crescents in biopsy as crescentic GN. Only very few studies1,2 have included the presence of <50% crescents as crescentic glomerulonephritis. The percentage of crescents in renal biopsy can vary with the timing of biopsy and the plane of cut during processing of the specimen. So considering the presence of >50% crescents alone as CrGN may underestimate the disease burden, treatment requirement and hence the outcome. AIM : To study clinical, biochemical, histological characteristics and outcomes of patient with crescentic glomerulonephritis MATERIALS and METHODS : It is a retrospective observational study. Study population were biopsy proven crescentic glomerulonephritis patients from Jan 2006 to December 2012. Initial demographic, clinico biochemical features, renal biopsy findings, dialysis requirement, treatment started and complications were collected. Follow up data regarding their dialysis requirement, Creatinine status, proteinuria and complications if any were collected till February 2014 at various intervals. Data was analyzed for whole cohort and Immune complex and Non immune complex crescentic GN were compared . RESULTS : A total of 265 patients between Jan 2006-Dec 2012 whose renal biopsies were reported as having more than 10% crescents were included in this study. The mean age of patients was 40.14 ± 14.34 years with median follow up period of 3(1-83) months. Females constituted 57% of the cohort, with a Female: Male ratio of 1.3:1. The commonest type of crescentic glomerulonephritis in our study was immune complex GN with Lupus nephritis being the most common cause accounting for 26% of total cohort. Next to lupus, pauci immune ANCA negative glomerulonephritis accounts for 18.9% of patients. When compared to Immune complex crescentic GN(ICCGN) patients Non immune complex crescentic GN(NICCGN) patients were older, anuric and had less extra renal manifestation except hemoptysis, lesser proteinuria, severe renal failure and more glomerular necrosis and severe IFTA in biopsy at presentation. CONCLUSIONS : Immune complex CGN was the commonest type. Non ICCGN patient had severe renal failure and less proteinuria and more dialysis dependency than ICCGN