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.

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P.C. Muraleedharan

Calicut University

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