Crescentic glomerulonephritis as renal cause of acute renal failure

Over a period of 5 years, we observed 28 patients with biopsy-proven crescentic glomerulonephritis. Four of these patients were ANCA associated (pauci immune), 1 had anti-glomerular basement membrane antibodies (anti-GBM), and the other 23 cases had immune complex form (22 poststreptococcal and 1 poststaphylococcal). Acute renal failure as a main clinical feature was found in 11/28 (35.7%), all with more than 80% crescents, including all ANCA-associated cases, anti-GBM form, and the patient with poststaphylococcal form. Using "pulse" therapy with methylprednisolone, cyclophosphamide, and plasmapheresis, renal function was improved in 5/11 (45.4%), diuresis started, and end-stage renal disease was delayed. The therapy was continued orally with steroids and cyclophosphamide. The second attach of oligoanuria developed after a period of 6-12 months without improvement after the therapy used previously (during the first attack), and it was necessary to begin chronic hemodialysis treatment.