Abstract
RPGN, a type of nephritic syndrome, accompanied by extensive glomerular crescent formation that, if untreated, progresses to end-stage renal disease over weeks to months. Our study aims to study the renal biopsy findings in patients with rapidly progressive glomerulonephritis and its impact on remission outcome.
Materials and Methods: A hospital based retrospective study conducted for a period of one year after obtaining ethical clearance. Adults with rapidly progressive glomerulonephritis on the basis of renal biopsy were included. Light microscopy renal biopsy findings at the baseline were obtained and treatment outcome was analyzed as per the biopsy finding. Treatment outcome identified the remission of the patient with 24-hour urine protein <500 mg/day and serum creatinine <1.4 mg/dl. Quantitative variables were compared using Mann-Whitney Test and qualitative variables were correlated using Chi-Square test/Fisher’s exact test. A p value of <0.05 was considered statistically significant.
Results: In our study, about two-third of patients (63.64%) had showed no response. About one-fourth (25.45%) of patients showed partial remission and 10.91% had complete remission. Three-fourth of patients who achieved remission in study had sclerosis in < 35% of their glomeruli, and between 50-75% of crescents in their glomeruli, suggesting to be a predictor of response, p<0.05
Conclusion: RPGN is an important cause of renal failure. Renal biopsy findings can correlate with the prognosis of the disease and the treatment outcome. An early referral to nephrologist for early diagnosis and treatment is stressed.
Keywords: glomerulonephritis, RPGN, nephritic syndrome, renal biopsy.
References
- Couser WG. Rapidly progressive glomerulonephritis: classification, pathogenetic mechanisms and therapy. Am J Kidney Dis1988; 11:449-64.
- Jennettee JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int 2003;63:1164-77.
- Cassidy MJD, Gaskin G, Savill J, Pusey CD, Rees AJ. Towards a more rapid diagnosis of rapidly progressive glomerulonephritis. Br Med J1990;301:329-31.
- Fischer EG, Lager DJ. Anti-glomerular basement membrane glomerulonephritis: A morphologic study of 80 cases. Am J Clan Pathol 2006;125:445-50
- Jayne DRW, Marshall PD, Jones SJ, Lockwood CM. Autoantibodies to GBM and neutrophil cytoplasm in rapidly progressive glomerulonephritis. Kidney Inter 1990; 37(3):965-70.
- Merkel F, Pulling O, Marx M, Netzer KO, Weber M. Courses and management of anti basement membrane antibody disease: report of 35 cases. Nephrol Dila Transplant 1994;9:372-76.
- Kluth DC, Rees AJ. Anti-glomerular basement membrane disease. J Am Soc Nephrol 1999;10 (11):2446-53.
- Chen S, Tang Z, Zhang Y, Liu Z, Zhang H, Hu W et al. Significance of histological crescent formation in patients with diffuse proliferative lupus nephritis. Am J Nephrol 2013; 38:445-52.
- Merrill JT, Neuwelt CM, Wallace DJ, Shanahan JC, Latinis KM, Oates JC et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum2010;62:222-33.
- Yu F, Tan Y, Liu G, Wang SX, Zou WZ, Zhao MH. Clinicopathological characteristics and outcomes of patients with crescentic lupus nephritis. Kidney Inter 2009; 76:307-17.
- Petterssen EE. Incidence and outcome of pauci immune necrotizing and crescentic glomerulonephritis in adults. Clin Nephrol 1995;43:141-49.
- Chen M, Yu F, Wang SX, Zou WZ, Zhao MH, Wang HY. Antineutrophil cytoplasmic autoantibody-negative pauci-immune crescentic glomerulonephritis. J Am Soc Nephrol 2007;18:599-605.
- Penelope PK, John PA, Boletis JN, Sotsiou F, Nakopoulou, Eugene Det al. Clinicopathologic predictors of death and ESRD in patients with pauci-immune necrotizing glomerulonephritis. Am J Kidney Dis2003;41:29-37.
- Day CJ, Howie AJ, Nightingale P, Shabir S, Adu D, Savage CO et al. Prediction of ESRD in pauci-immune necrotizing glomerulonephritis: quantitative histomorphometric assessment and serum creatinine. Am J Kidney Dis 2010; 55(2):250-58.
- Fauci AS, Haynes BF, Katz P. The spectrum of vasculitis. Clinical pathology. Immunology and therapeutic considerations. Ann Intern Med1978;89:660-76
- Cassidy MJD, Gaskin G, Savill J, Pusey CD, Rees AJ. Towards a more rapid diagnosis of rapidly progressive glomerulonephritis. Br Med J 1990;301:329-31.
- Marta K, Mglianas M, Agne. Histopatho-logical Classification- A Prognostic tool for Rapidly Progressive Glomerulonephritis. Medicinia 2018, 54(2),17.
- Guettier C, Nochy D, Jacquot C. Immunohistochemcial demonstration of parietal epithelial cells and macrophages in human proliferative extra capillary lesions. Virchows Archiv A 1986;409(5):739-48.
- Lin W, Chen M, Cui Z, Zhao MH. The immunopathological spectrum of crescentic glomerulonephritis: A survey of 106 patients in a single Chinese center. Nephron Clin Pract 2010;116:c65-c74.
- Naidu GS, Sharma A, Nada R, Kohli HS, Jha V, Gupta KL et al. Histopathological classification of pauci-immune glomerulnephritis and its impact on outcome. Rheumatol Int 2014;34(12):1721-7.
- Tang Z, Wu Y, Yao XD, Hu WX, Chen HP, Li SL. The clinical and pathological characteristics of Chinese patients with pauci-immune crescentic glomerulonephritis. Chin Med J (Engl)2001; 114:374-8.
- El -Husseini AA, El-Agroudy AE, Moustafa FE, Fouda MA, Sobh MA. Impact of clinical and histopathological factors on outcome of Egyptian patients with crescentic glomerulonephritis. Int Urol Nephrol 2003; 35:543-51.
Corresponding Author
Pankaj Banotra
Residents, Department of General Medicine, Government Medical College, Jammu
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.03
