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[Clinical and morphologic predictors of the progress of chronic glomerulonephritis]
Insights
Chronic glomerulonephritis (CGN) progression to chronic renal failure (CRF) significantly depends on clinical and morphological patterns. Active nephritic and nephrotic-hypertonic patterns show rapid CRF development, while inactive or corticoid-sensitive patterns exhibit slower progression.
Area of Science:
- Nephrology
- Pathology
Context:
- Chronic glomerulonephritis (CGN) is a leading cause of chronic kidney disease.
- Understanding disease progression is crucial for patient management and treatment strategies.
Purpose:
- To investigate the relationship between clinical and morphological patterns of CGN and the development of chronic renal failure (CRF).
- To identify key predictors of CGN disease progression.
Summary:
- A study of 183 patients with CGN revealed significant correlations between disease patterns and CRF development.
- Active nephritic and nephrotic-hypertonic CGN patterns were associated with rapid CRF onset within 5 years.
- Inactive nephritic and corticoid-sensitive nephrotic patterns showed slower progression, with minimal CRF over 20 years.
- Focal-segmental glomerular hyalinosis/sclerosis was the most unfavorable morphological pattern, leading to CRF in nearly 50% of patients within 5 years.
- Mesangioproliferative and membranous patterns were more favorable.
- The presence of sclerotic lesions after 2 years significantly increased the 10-year risk of CRF (65% vs. 9%).
- Key predictors of CRF were the clinical CGN pattern and the presence of sclerotic lesions on renal biopsy.
Impact:
- This research provides valuable insights into predicting CGN outcomes.
- Identifies specific patient subgroups at higher risk for rapid disease progression.
- Informs clinical decision-making for tailored therapeutic interventions in CGN management.
Abstract:
Observation over 183 patients with a morphologically verified diagnosis of chronic glomerulonephritis (CGN) made it possible to establish on a mathematic basis a highly significant relationship between the disease progress and the clinical and morphological disease patterns. In the active nephritic patterns and in the nephrotic-hypertonic pattern, chronic renal failure (CRF) occurred in the majority of the patients within the first 5 years. Meanwhile in the inactive nephritic pattern and in the nephrotic pattern, a corticoid-sensitive one, characterized by the phasic course, CRF could not almost be seen over up to 20 years after the disease onset. As far as the morphological patterns are concerned, focal-segmental glomerular hyalinosis/sclerosis turned out most unfavourable. In patients with this pattern, CRF was diagnosed during 5 years in almost half of the patients. The mesangio proliferative and membranous patterns appeared most favourable. The incidence of CRF during 5 years after the disease onset, common to the definite clinical patterns, did not depend on the concomitant morphological pattern. Provided there were sclerotic lesions throughout 2 years after the disease onset, CRF occurred in 65% of the cases for 10 years, whereas with their lack in 9% of the cases. The most important predictors of CRF were as follows: the clinical pattern of CGN and the presence of sclerotic lesions in the renal biopsy specimen. Of definite significance might be the morphological pattern of CGN.