Analysis of risk factors for patient and renal survival in crescentic glomerulonephritis

A series of 57 patients with crescentic glomerulonephritis was studied retrospectively to estimate patient and renal survival and to analyze the variables that affect these end points. Renal survival was 47% at 6 months for patients with idiopathic rapidly progressive glomerulonephritis and 33% for patients with antiglomerular basement membrane disease. Most patients in these two groups presented with advanced renal insufficiency. Renal survival rates for patients with systemic illness, with or without a tissue diagnosis of vasculitis, were 93% and 100%, respectively, at 1 year. These patients had better renal function at presentation. Overall, patient survival at 5 years was 61%, and there were no significant differences among the groups. A systematic analysis of clinical, immunopathologic, and laboratory variables showed that the initial serum creatinine level and oliguria and the patient's age and oliguria were the most important indicators of renal and patient survival, respectively. Virtually all patients with a creatinine level greater than 6.0 mg/dL lost their kidneys. Five-year survival for patients greater than 60 years old was 31%, compared with 83% for those less than or equal to 60 years. Moderate-to-severe tubulointerstitial inflammation indicated worse patient and renal survival, and 24-hour urine protein excretion greater than 3 g was related to shorter renal survival. We have identified and ranked a number of variables that affect patient or renal survival in crescentic glomerulonephritis. These findings may be of help in the decision-making process of patient management and analysis of treatment modalities.