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The Clinicopathological Correlation and Outcome of Glomerulonephritis With Crescent: A Single-Center Study
Rajeshwar Rao1, Prit P Singh1, Om Kumar1
1Nephrology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND.
Insights
Glomerulonephritis (GN) with higher crescent percentages indicates a worse prognosis. Increased crescents correlate with treatment resistance and a greater risk of renal failure in GN patients.
Area of Science:
- Nephrology
- Pathology
- Internal Medicine
Background:
- Standardized treatments for glomerulonephritis (GN) with <50% crescents are lacking.
- This study investigates clinicopathological features and renal outcomes in GN patients with at least one crescent.
Purpose of the Study:
- To analyze the impact of crescent percentage on clinicopathological characteristics and renal prognosis in GN.
- To identify factors associated with treatment resistance and renal failure in crescentic GN.
Main Methods:
- Retrospective cohort study of 145 GN patients (age 18-65) with renal biopsy evidence of crescents.
- Data collected included demographics, clinical presentation, and renal biopsy findings from January 2016 to December 2020.
Main Results:
- Higher crescent percentage (≥50%) was linked to increased hemoptysis, rapidly progressive glomerulonephritis (RPGN), and ANCA-associated vasculitis.
- Significant differences observed in mean creatinine, crescent count, and urine PCR based on crescent percentage.
- Complete remission decreased with increasing crescents; fibrous crescents (≥50%) showed 100% treatment resistance.
Conclusions:
- Crescent percentage and crescent age are significant predictors of renal failure risk.
- Higher crescent burden is associated with increased resistance to treatment in GN.
Background:
There is a lack of standardized treatments for patients with less than 50% crescents observed in their renal biopsies. This study aimed to analyze the crescent percentage, clinicopathological characteristics, and renal prognosis of glomerulonephritis (GN) cases with at least one crescentic lesion.
Materials And Methods:
This retrospective cohort study was conducted at the Indira Gandhi Institute of Medical Sciences, Patna, from January 2016 to December 2020. Consecutive patients (aged between 18 and 65 years) with renal biopsy findings suggestive of GN and at least one crescent were included in the study. Demographic details and clinical presentation were collected from the medical records.
Results:
A total of 145 patients were included. The mean (standard deviation (SD)) age was 33.06 (11.739) years. Hemoptysis was significantly higher in the ≥50% crescent group (P=0.011). Rapidly progressive glomerulonephritis (RPGN) was significantly higher in the ≥50% crescent group (P<0.001). There was a significant difference observed in mean creatinine (P=0.001), mean crescents (P<0.001), and mean urine polymerase chain reaction (PCR) (P=0.031). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was significantly higher in the ≥50% crescent group (P<0.001). Complete remission decreased as crescents increased. In GN with crescent, the presence of fibrous crescents (≥50%) is associated with a higher rate of treatment resistance (100%) compared to fibrocellular (58.33%) and cellular crescents (6.25%). In the ≥50% crescent group, death was significantly higher in patients with fibrous crescent age (57.14%).
Conclusion:
Crescent percentage and crescent age were found to be significantly related to greater risk of renal failure and resistance to treatment.
