Nagaraju Shankar Prasad, Laxminarayana Sindhura Lakshmi Koulmane, Kosuru Srinivas, Parthasarathy Rajeevalochana, Attur Ravindra Prabhu, Rangaswamy Dharshan, Matteti Uday Venkat, Guddattu Vasudeva
Associate Professor, Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Assistant Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
J Clin Diagn Res. 2017 Sep;11(9):OC21-OC24. doi: 10.7860/JCDR/2017/28307.10621. Epub 2017 Sep 1.
Diffuse Crescentic glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure and has grave prognosis. There is significant regional and temporal variation in aetiology, prevalence and prognosis of diffuse crescentic glomerulonephritis (CrGN) with limited data available in adult Indian population.
This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population.
In this retrospective study, clinical records of all adults (>18 years) over a 5-year period (2010-2014) with a histopathological diagnosis of diffuse CrGN (>50% crescents) were reviewed. Clinical, serological, biochemical and histopathological data were collected. Follow-up data at six months including renal outcome and mortality were studied. Data was analysed using SPSS version 15.
There were 29 cases of diffuse CrGN accounting for an incidence of 2.9% among 1016 non-transplant kidney biopsies. The most common cause was pauci-immune crescentic GN. The median creatinine at admission was 7.2 mg/dl {(interquartile range (IR) 3.3 - 10.4)} and 75.9% of patients required haemodialysis at admission. Complete/partial recovery was seen in 34.5%. At the end of six months 31% were dialysis dependent and the mortality was 27.6%. On univariate analysis, the significant predictors of renal loss and mortality were oliguria (p=0.02), requirement of haemodialysis and serum creatinine (p=0.001) at admission (>5.5mg/dl) (p=0.003). Histopathological features did not influence the outcome in our study.
In our cohort, the most common cause for diffuse CrGN is pauci-immune CrGN. Diffuse CrGN carries a poor prognosis. Patients with pauci-immune and AntiGBM disease have worst prognosis compared to immune complex CrGN. The presence of oliguria, high serum creatinine and requirement of haemodialysis at admission are associated with poor outcomes.
弥漫性新月体性肾小球肾炎（CrGN）的特征是肾功能快速进展且预后严重。弥漫性新月体性肾小球肾炎（CrGN）的病因、患病率和预后在地域和时间上存在显著差异，而印度成年人群中的相关数据有限。
本研究旨在确定印度南部人群中弥漫性CrGN的病因、临床病理特征及预后。
在这项回顾性研究中，对所有在5年期间（2010 - 2014年）组织病理学诊断为弥漫性CrGN（新月体>50%）的成年患者（>18岁）的临床记录进行了回顾。收集了临床、血清学、生化和组织病理学数据。研究了包括肾脏预后和死亡率在内的6个月随访数据。使用SPSS 15版软件进行数据分析。
在1016例非移植肾活检中，有29例弥漫性CrGN病例，发病率为2.9%。最常见的病因是寡免疫性新月体性肾小球肾炎。入院时肌酐中位数为7.2mg/dl{（四分位间距（IR）3.3 - 10.4）}，75.9%的患者入院时需要血液透析。34.5%的患者实现了完全/部分恢复。6个月末，31%的患者依赖透析，死亡率为27.6%。单因素分析显示，肾丢失和死亡的显著预测因素为少尿（p = 0.02）、入院时需要血液透析以及血清肌酐（p = 0.001）（>5.5mg/dl）（p = 0.003）。在我们的研究中，组织病理学特征并未影响预后。
在我们的队列中，弥漫性CrGN最常见的病因是寡免疫性CrGN。弥漫性CrGN预后不良。与免疫复合物性CrGN相比，寡免疫性和抗肾小球基底膜病患者的预后最差。入院时存在少尿、高血清肌酐和需要血液透析与不良预后相关。
