Shankar Prasad Nagaraju1, Sindhura Lakshmi Koulmane Laxminarayana2, Srinivas Kosuru3, Rajeevalochana Parthasarathy4, Ravindra Prabhu Attur5, Dharshan Rangaswamy1, Uday Venkat Matteti6, Vasudeva Guddattu7. 1. Associate Professor, Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. 2. Assistant Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. 3. Consultant Nephrologist, Department of Nephrology, Mahatma Gandhi Hospitals, Narasaraopet, Guntur Dist, Andhra Pradesh, India. 4. Associate Consultant, Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India. 5. Professor, Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. 6. Assistant Professor, Department of Pharmacy Practice, Ngsm Institute of Pharmaceutical Sciences, Nitte University, Mangalore, Karnataka, India. 7. Associate Professor, Department of Statistics, Manipal University, Manipal, Karnataka, India.
Abstract
INTRODUCTION: 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. AIM: This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
INTRODUCTION: 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. AIM: This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: A Gigante; C Salviani; K Giannakakis; E Rosato; B Barbano; A Moroso; M L Gasperini; I Nofroni; F Salsano; R Cianci; F Pugliese Journal: Int J Immunopathol Pharmacol Date: 2012 Jan-Mar Impact factor: 3.219
Authors: Suceena Alexander; Sabina Yusuf; Gautham Rajan; Elenjickal Elias John; Sanjeet Roy; V C Annamalai; Athul Thomas; Jeethu Joseph Eapen; Anna T Valson; Vinoi George David; Santosh Varughese Journal: Wellcome Open Res Date: 2020-07-08