Title: Significance of Histological variables in Acute Endocapillary Proliferative Glomerulonephritis in Adults
Authors: P.C. Muraleedharan, N.K. Supriya, K P Aravindan, M. Sreelatha
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.22
Abstract
Background- The prognosis of diffuse endocapillary proliferative glomerulonephritis of post infectious etiology in adults is variable with a significant proportion of patients having an adverse outcome. It would be useful if the disease outcome could be predicted by histological variables in the initial renal biopsy.
Objectives- a) To compare the clinical outcome of patients with infection related glomerulonephritis having different clinical and histological parameters at the time of initial renal biopsy. b) To construct a scoring system capable of predicting cases with bad outcome.
Methods- Design: Retrospective cohort study done at Government Medical College Kozhikode from January 2004 to June 2008. The status of patients diagnosed to have diffuse endocapillary proliferative glomerulonephritis in renal biopsy were collected by noting clinical symptoms, blood pressure, serum creatinine and urine routine findings. Statistical analysis were conducted using SPSS version 10.The patients were grouped into good and poor outcome groups based on clinical and laboratory findings at the end of a minimum period of six months follow up. Good outcome group had complete resolution or only minor urinary abnormalities and poor outcome group included patients who died due to disease or had either persistence of significant urinary abnormalities or a serum creatinine of 2 mg/dl or greater. Histopathological parameters were semi quantitatively graded and these along with clinical parameters were compared between two groups. The clinical and histological variables that were significantly different between the two outcome groups were used to construct a predictive scoring system.
Results- Of the 56 biopsies diagnosed as diffuse endocapillary proliferative glomerulonephritis there were 34 cases in which adequate follow up was available. 9 cases belonged to the poor outcome (26.5%) and rest to the good outcome group .The variables that differed significantly in the two groups were S Creatinine (p=0.006), Crescents (p=0.002), Glomerular sclerosis (p=.001) and Interstitial fibrosis (p=0.0001)
Serum creatinine values and the grades of three histological parameters were added up for a predictive score. Predictive scores ≥ 7 had a sensitivity of 0.89 and a specificity of 0.96 for predicting cases with adverse outcome.
Conclusions- Initial serum creatinine and selected graded histological parameters on renal biopsy done at the outset can predict eventual outcome of diffuse endocapillary proliferative glomerulonephritis with a high sensitivity and specificity.
References
- Cynthia C Nast Infection-Related Glomerulonephritis: Changing Demographics and Outcomes , Advances in Chronic Kidney Diseases,March 2012 Volume 19, Issue 2, Pages 68–75
- Rodriguez-Iturbe and James M. Musser The Current State of PoststreptococcalGlomerulonephritis J Am Soc Nephrol 2008,19: 1855–1864.
- Montseny JJ, Meyrier A, Kleinknecht D, Callarsd P.Current spectrum of infectious glomerulonephritis-Experience with 76 patients and review of literature Medicine (Baltimore). 1995 Mar;74(2):63-73.
- Das U,Dakshinamurty K V,Prayaga A ,Pattern of biopsy-proven renal disease in a single center of south India: 19 years experience ,Indian Journal of Nephrology,2011 , |Volume 21, Issue 4 ,Page : 250-257
- Pakash J, Saxena RK, Sharma OP: Spectrum of renal diseases in the elderly: Single center experience from a developing country. Int Urol Nephrol33 : 227 –233, 2001
- Samih H. Nasr , Jai Radhakrishnan ,Vivette D. D’Agati Bacterial infection–related glomerulonephritis in adults Kidney International (2013) 83, 792–803
- Nasr SH, Markowitz GS Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature Medicine (Baltimore). 2008 Jan;87(1):21-32.
- Trivedi, A. Pasari, A. R. Chowdhury, A. A. Kurien,and R. Pandey. The Epidemiology, Clinical Features, and Outcome of Infection-related Glomerulonephritis from East India: A Single Center Experience Indian Journal of NephrologyJul-Aug; 27(4): 307–312
- Richards J Acute post-streptococcal glomerulonephritis W V Med J. 1991 Feb;87(2):61-5
- Moroni G, Pozzi C, Quaglini S, SegagniS, Long‐term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults Nephrology Dialysis Transplantation, Volume 17, Issue 7, 1 July 2002, Pages 1204–1211
- Vogl W, Renke M, Mayer-Eichberger D, Schmitt H, Bohle A. Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults. Nephron. 1986;44:58-65.
- Wen YK Clinicopathological study of infection-associated glomerulonephritis in adultsInt Urol Nephrol. 2010 Jun;42(2):477-85
- Jennings RB, Earle DP. Post-streptococcal glomerulo-nephritis: histopathologic and clinical studies of the acute, subsiding acute and early chronic latent phases. J Clin Invest. 1961;40:1525-95.
- Baldwin DS, Gluck MC, Schacht RG, Gallo G. The long-term course of poststreptococcal glomerulonephritis. Ann Intern Med. 1974;80:342-58
- Lewy JE, Salinas-Madrigal L, Herdson PB, Pirani CL, Metcoff J. Clinico-pathologic correlations in acute poststreptococcal glomerulonephritis. A correlation between renal functions, morphologic damage and clinical course of 46 children with acute poststreptococcal glomerulonephritis. Medicine (Baltimore). 1971;50:453-501.
- Hoy WE, White AV, Dowling A, Sharma SK, Bloomfield H, Tipiloura BT, et al. Post-streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life. Kidney Int. 2012;81:1026–32.