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Spectrum of rapidly progressive (crescentic) glomerulonephritis in northern India
Insights
Extracapillary proliferation significantly impacts renal function, often leading to poor outcomes. However, early treatment and fewer crescents improve prognosis in rapidly progressive glomerulonephritis.
Area of Science:
- Nephrology
- Pathology
- Immunology
Background:
- Extracapillary proliferation is a severe histological finding in kidney biopsies.
- Rapidly declining renal function necessitates understanding prognostic factors.
Purpose of the Study:
- To review outcomes of patients with significant extracapillary proliferation.
- To identify factors associated with renal function recovery.
Main Methods:
- Retrospective review of 36 patients with extracapillary proliferation and declining renal function.
- Analysis of clinical presentation, etiology, histological findings, and treatment outcomes.
Main Results:
- 28 of 36 patients died within 10 months; 6 patients survived with renal function recovery.
- Survivors shared factors: antecedent disease, fewer/smaller crescents, less interstitial damage, and early treatment.
- Rebiopsy in survivors showed histological improvement.
Conclusions:
- Significant extracapillary proliferation portends a poor prognosis.
- Early intervention and favorable histological features are crucial for recovery in rapidly progressive glomerulonephritis.
Abstract:
36 consecutive patients whose biopsies showed significant extracapillary proliferation in the face of rapidly declining renal function were reviewed between 1967 and 1979. About 30% of the patients belonged to the pediatric age group with a male:female ratio of 2.5:1. Oliguria/anuria, hematuria, and progressive renal insufficiency were present in all cases. There was evidence of 9 cases being poststreptococcal, 2 SLE, 1 Henoch-Schönlein purpura, 2 possibly viral and 1 staphylococcal. Histologically, 29 cases had more than 60% crescents, 5 between 50 and 60% and 2 cases a little less than 50%. 28 cases were fatal in less than 10 months. 2 were lost of follow-up. 6 survivors with reversal of renal functions had 3 common factors to note, namely an antecedent disease, less crescents both in number and size, accompanied by fewer interstitial changes and early treatment. Rebiopsy in 2 survivors showed regression of histologic severity.