Quiroga B, Vega A, Rivera F, López-Gómez J M
Hospital Gregorio Marañón, Madrid, Spain.
Hospital General de Ciudad Real, Ciudad Real, Spain.
Intern Med J. 2015 May;45(5):557-62. doi: 10.1111/imj.12725.
Crescentic glomerulonephritis (CGN) is a histological finding that implies rapid deterioration of renal function and can be related to different diseases, such as type 1 or anti-glomerular basement membrane antibody (Goodpasture) disease, type 2 or immune complex CGN and type 3 or pauci-immune disease.
The present study describes CGN and its characteristics based on the data from the Spanish Glomerulonephritis Registry.
An analysis was made of all native renal biopsies obtained from patients during 1994-2013 and classified as CGN. A patient epidemiological and clinical data questionnaire was completed by the 120 centres involved.
A total of 21,774 biopsies was performed, of which 2089 (8.1%) corresponded to CGN (211 type 1, 177 type 2 and 1701 type 3). Renal function was poorer in type 1 compared with types 2 and 3, and proteinuria was higher in type 2 compared to types 1 and 3. Patients diagnosed with CGN type 3 were older than those with types 1 and 2, but less hypertensive than the type 2 patients. No differences in the urine test findings were found between types 1 and 2. Microhaematuria was the most frequent feature in general, as well as in type 3 compared with types 1 and 2. The main indication for biopsy was acute renal injury. Age was the only difference between type 1 patients with and without alveolar haemorrhage (53 [33-67] vs 64 [46-73], P = 0.008).
Although classified as the same entity, the different types of CGN have different features that must be taken into account.
新月体性肾小球肾炎（CGN）是一种组织学表现，提示肾功能迅速恶化，可与多种不同疾病相关，如1型或抗肾小球基底膜抗体（Goodpasture）病、2型或免疫复合物性CGN以及3型或寡免疫性疾病。
本研究基于西班牙肾小球肾炎登记处的数据描述CGN及其特征。
对1994年至2013年期间从患者获取的所有原发性肾活检进行分析，并分类为CGN。参与研究的120个中心完成了患者流行病学和临床数据问卷。
共进行了21774例活检，其中2089例（8.1%）为CGN（1型211例，2型177例，3型1701例）。1型患者的肾功能比2型和3型患者差，2型患者的蛋白尿比1型和3型患者高。诊断为3型CGN的患者比1型和2型患者年龄大，但高血压程度低于2型患者。1型和2型患者的尿液检查结果无差异。镜下血尿是最常见的特征，在总体上以及3型患者中比1型和2型患者更常见。活检的主要指征是急性肾损伤。有和无肺泡出血的1型患者之间唯一的差异是年龄（53[33 - 67]岁对64[46 - 73]岁，P = 0.008）。
尽管被归类为同一实体，但不同类型的CGN具有不同特征，必须予以考虑。
