Glomerulonephritis with crescents in adults − clinico −pathological characteristics and determinants of outcome

Nagaraju, Shankar Prasad and Kosuru, Srinivas and Parthasarathy, Rajeevalochana and Bairy, Manohar and Prabhu, Ravindra and Guddattu, Vasudeva and Lakshmi, Sindhura KL (2014) Glomerulonephritis with crescents in adults − clinico −pathological characteristics and determinants of outcome. Nephrology Dialysis Transplantation, 29 (Supl-3). pp. 186-200.

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Abstract

Introduction and Aims: Glomerulonephritis with crescents (CrGN) is a serious renal condition, which can progress rapidly leading to loss of renal function and/or death. We studied the clinical, pathological features and outcome of CrGN in adults. Methods: After obtaining ethical committee clearance, all adults (>18 years) over a 5-year period (2008-2013) with a histopathological diagnosis of glomerulonephritis with crescents were included in this retrospective study. Clinical, biochemical, serological and histopathological data were collected. Patients were classified intodiffuse group (>50%crescents) and focal group (<50%crescents). Follow-up data including renal outcome and mortality was collected for 6 months. Data was analyzed using SPSS version 15. Results: Of the fifty six patients studied, 20 patients had diffuse crescentic GN and 36 had GN with focal crescents (Figure 1). The baseline clinical, demographic and histopathological features are depicted in table 1. Immune complex GN was the commonest cause of GN with focal crescents (72%) and Pauci-immune GN accounted for most of the diffuse CrGN (40%). As compared to focal CrGN ,patients with diffuse CrGN had significantly higher serum creatinine( p-0.001), hemodialysis (HD) requirement at admission (p-<0.001),tuft necrosis (p-0.02), bowman’s capsular rupture (p-0.001) and obsolescent glomeruli( p-0.03). At the end of six months follow-up, diffuse CrGN patients had poorer renal outcome and higher mortality (p-0.05) (Table 2). On multivariate logistic regression, requirement of HD at admission predicted mortality and poor renal outcome irrespective of the focal or diffuse distribution of the crescents. Conclusions: In our cohort, Immune complex GN and Pauci-immune GN were the commonest causes of focal and diffuse CrGN respectively. Incidence of end stage renal disease and mortality were significantly higher in patients with diffuse CrGN. Regardless of the focal or diffuse nature of the crescents, requirement of HD at admission predicted mortality and poor renal outcome.

Item Type: Article
Subjects: Departments at MU > Statistics
Medicine > MMMC Manipal > Pathology
Medicine > KMC Manipal > Nephrology
Depositing User: KMC Manipal
Date Deposited: 19 Jun 2014 04:41
Last Modified: 19 Jun 2014 04:41
URI: http://eprints.manipal.edu/id/eprint/139818

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