Crescentic glomerulonephritis: immune vs. nonimmune mechanisms

An immunopathological study of renal biopsies from 38 patients with glomerulonephritis with greater than 30% crescents was performed. All had evidence of immune deposits in glomeruli: 9 were characterized by linear fluorescence staining (antiglomerular basement membrane antibodies) and 29 had granular capillary wall and/or mesangial deposits. In the former group, 3 (33%) had associated pulmonary hemorrhage. In the latter group, the glomerular lesions in 18 (62%) were part of well-defined systemic illnesses, whereas in the remainder, the abnormalities were apparently limited to the kidney. The prognosis was uniformly grave, for all patients with adequate follow-up developed end-stage renal failure or died. In contrast to other reports of crescentic glomerulonephritis, we could not document the existence of an 'immunofluorescence negative' form of crescentic glomerulonephritis.