Baikunje Shashidhar, Vankalakunti Mahesha, Nikith A, Srivatsa A, Alva Suhan, Kamath Janardhan
Department of Nephrology , Singapore General Hospital , Singapore , Singapore.
Department of Nephropathology , Manipal Hospital , Bangalore , India.
Clin Kidney J. 2016 Apr;9(2):222-6. doi: 10.1093/ckj/sfv147. Epub 2016 Jan 20.
Crescent formation generally reflects severe glomerular injury. There is sparse literature on post-infectious glomerulonephritis (PIGN) with crescents in adults. This retrospective study looked at nine such cases to see if there is a correlation between the severity of presentation, steroid treatment, histological severity and outcome.
Biopsy reports of all the adults who underwent kidney biopsy from February 2010 to June 2014 in a tertiary care hospital were screened and all the cases with the diagnosis of PIGN with crescents were selected. Clinical presentation, laboratory data, histology, treatment and outcome were analysed.
Six patients had evidence of recent/current infection, but all except two were non-streptococcal. The mean creatinine was 360.67 μmol/L (range 70.72-770.85) and the mean estimated glomerular filtration rate (MDRD eGFR) was 30.28 mL/min/1.73 m(2) (range 6.4-111.1) on presentation. All five patients who were treated with steroids had an excellent response. Among the four patients who did not receive steroids, two were left with significant renal impairment (mean MDRD eGFR 23.5 mL/min/1.73 m(2)) at a mean follow-up of 15.5 months (range 10-21). The mean percentage of glomeruli with crescents was 36.13% (range 11.76-100) and except in one, there was no tubular atrophy or interstitial fibrosis and none had glomerulosclerosis. None of the patients progressed to end-stage renal disease.
Non-streptococcal infections are more common precipitants. There was no correlation between histological and clinical severity. Patients treated with steroids had better renal outcomes.
新月体形成通常反映严重的肾小球损伤。关于成人感染后肾小球肾炎（PIGN）合并新月体的文献较少。本回顾性研究观察了9例此类病例，以探讨临床表现的严重程度、类固醇治疗、组织学严重程度与预后之间是否存在相关性。
筛选了2010年2月至2014年6月在一家三级护理医院接受肾活检的所有成人患者的活检报告，并选取了所有诊断为PIGN合并新月体的病例。分析了临床表现、实验室数据、组织学、治疗及预后情况。
6例患者有近期/当前感染的证据，但除2例外均为非链球菌感染。就诊时平均肌酐为360.67μmol/L（范围70.72 - 770.85），平均估计肾小球滤过率（MDRD eGFR）为30.28 mL/min/1.73 m²（范围6.4 - 111.1）。所有接受类固醇治疗的5例患者反应良好。在未接受类固醇治疗的4例患者中，2例在平均随访15.5个月（范围10 - 21个月）时仍有明显肾功能损害（平均MDRD eGFR 23.5 mL/min/1.73 m²）。新月体肾小球的平均百分比为36.13%（范围11.76 - 100），除1例患者外，均无肾小管萎缩或间质纤维化，也无肾小球硬化。所有患者均未进展至终末期肾病。
非链球菌感染是更常见的诱因。组织学严重程度与临床严重程度之间无相关性。接受类固醇治疗的患者肾脏预后较好。
