[Diagnosis and treatment of rapidly progressive glomerulonephritis. An analysis of 20 cases]

In order to know the incidence and character of rapidly progressive glomerulonephritis (RPGN) in China, 20 patients with RPGN were analysed and 10 of them followed. Their diagnosis were confirmed by biopsy showing extensive crescent formation. Five patients were rebiopsied. RPGN was found in about 3% of the patients with glomerulonephritis in our center. Only one case was mediated by anti-GBM antibody, while the other 19 by immune complex. Prodromal infection was common (12/20). Hematuria, nephrotic syndrome and hypertension were found in 20, 15 and 12 patients respectively. Five patients without special treatment died of renal cause within 6 months. Intensive treatment (pulse methylprednisone or plasmapheresis) was effective in all of the four cases with cellular crescents. After the treatment, their renal function improved with decrease of proliferation and crescent formation as shown by rebiopsy. However, deterioration of renal function reappeared after 3 months to 3 years in three of the cases. It is shown that in China, RPGN was predominantly mediated by immune complex and is associated with a high incidence of prodromal infection. Clinically, nephrotic syndrome was more frequently seen here than in western countries. For improvement of the prognosis, it is necessary to pay attention not only to earlier diagnosis but also to protection of renal function after intensive therapy.