Two distinct types of crescentic glomerulonephritis.

For a characterization of the clinical course of crescentic glomerulonephritis (Cres. GN), reciprocals of serum creatinine concentration (1/Cr) as a function of time were studied in 24 patients. The patients fulfilled the following criteria; 1) crescents were observed in more than 50% of glomeruli, and 2) the increment of serum creatinine could be determined sequentially on three or more occasions in the phase of progression of renal impairment. In all patients 1/Cr declined linearly with time with correlation coefficients between 0.881 and 0.993. According to the slope, the patients were divided into two groups; an acute group (13 patients) with slopes of -1.0 x 10(-2) dl/mg/day or more steep, i.e. with increments of serum creatinine from 1.0 to 10.0 mg/dl within 90 days, and a subacute group (11 patients) with less steep slopes. Histologically, there was no difference in the percentage of glomeruli with crescents between the two groups. However, in the acute group a negative correlation was found between the period from onset to histological examination and the percentage of glomeruli with cellular crescents in all glomeruli with various crescents (r = -0.872, p less than 0.001), while in the subacute group the percentage was nearly constant regardless of the time of histological examination. These mean drastic but transient activation of the disease in the former in spite of a persistence of indolent activity in the latter. Clinically, in the acute group an improvement of serum creatinine was observed in 8 (61.5%) vs. only 2 (18.2%) in the subacute group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)