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Clinicopathological Characteristics and Outcomes of Diffuse Crescentic Glomerulonephritis - A Single Center

Shankar Prasad Nagaraju1, Sindhura Lakshmi Koulmane Laxminarayana2, Srinivas Kosuru3

  • 1Associate Professor, Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

Journal of Clinical and Diagnostic Research : JCDR
|December 7, 2017
PubMed

Insights

Diffuse crescentic glomerulonephritis (CrGN) in India is most commonly pauci-immune, carrying a poor prognosis. Oliguria, high creatinine, and dialysis at admission predict worse outcomes for CrGN patients.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Diffuse crescentic glomerulonephritis (CrGN) presents as rapidly progressive renal failure with a grave prognosis.
  • Data on the aetiology, prevalence, and outcomes of CrGN in the adult Indian population are limited.
  • Understanding CrGN in diverse populations is crucial for improving patient management.

Purpose of the Study:

  • To determine the aetiology of diffuse CrGN in the South Indian population.
  • To analyze the clinical and pathological features of diffuse CrGN.
  • To evaluate the renal outcomes and mortality rates associated with diffuse CrGN.

Main Methods:

  • A retrospective review of adult patients diagnosed with diffuse CrGN (>50% crescents) between 2010 and 2014.
  • Collection of clinical, serological, biochemical, and histopathological data.
  • Six-month follow-up assessing renal outcomes and mortality, with data analyzed using SPSS version 15.

Main Results:

  • Diffuse CrGN accounted for 2.9% of non-transplant kidney biopsies (29 cases).
  • Pauci-immune crescentic GN was the most common aetiology.
  • Poor outcomes were observed: 34.5% complete/partial recovery, 31% dialysis-dependent at 6 months, and 27.6% mortality.
  • Oliguria, high admission creatinine (>5.5mg/dl), and need for hemodialysis predicted poor renal outcomes and mortality.

Conclusions:

  • Pauci-immune CrGN is the predominant cause of diffuse CrGN in this South Indian cohort.
  • Diffuse CrGN is associated with a poor prognosis, particularly in pauci-immune and Anti-GBM disease cases.
  • Admission factors like oliguria, elevated creatinine, and requirement for hemodialysis are critical indicators of poor prognosis in diffuse CrGN.
Abstract

Keywords:
Anti-GBM diseaseImmune-complex glomerulonephritisPauci-immune glomerulonephritis

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