Rao Rajeshwar, Singh Prit P, Kumar Om, Krishna Amresh, Patel Prem S
Nephrology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND.
Cureus. 2024 Feb 26;16(2):e54996. doi: 10.7759/cureus.54996. eCollection 2024 Feb.
There is a lack of standardized treatments for patients with less than 50% crescents observed in their renal biopsies. This study aimed to analyze the crescent percentage, clinicopathological characteristics, and renal prognosis of glomerulonephritis (GN) cases with at least one crescentic lesion.
This retrospective cohort study was conducted at the Indira Gandhi Institute of Medical Sciences, Patna, from January 2016 to December 2020. Consecutive patients (aged between 18 and 65 years) with renal biopsy findings suggestive of GN and at least one crescent were included in the study. Demographic details and clinical presentation were collected from the medical records.
A total of 145 patients were included. The mean (standard deviation (SD)) age was 33.06 (11.739) years. Hemoptysis was significantly higher in the ≥50% crescent group (P=0.011). Rapidly progressive glomerulonephritis (RPGN) was significantly higher in the ≥50% crescent group (P<0.001). There was a significant difference observed in mean creatinine (P=0.001), mean crescents (P<0.001), and mean urine polymerase chain reaction (PCR) (P=0.031). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was significantly higher in the ≥50% crescent group (P<0.001). Complete remission decreased as crescents increased. In GN with crescent, the presence of fibrous crescents (≥50%) is associated with a higher rate of treatment resistance (100%) compared to fibrocellular (58.33%) and cellular crescents (6.25%). In the ≥50% crescent group, death was significantly higher in patients with fibrous crescent age (57.14%).
Crescent percentage and crescent age were found to be significantly related to greater risk of renal failure and resistance to treatment.
对于肾活检中新月体比例小于50%的患者，缺乏标准化治疗方法。本研究旨在分析至少有一个新月体病变的肾小球肾炎（GN）病例的新月体比例、临床病理特征及肾脏预后。
本回顾性队列研究于2016年1月至2020年12月在巴特那英迪拉·甘地医学科学研究所进行。研究纳入了年龄在18至65岁之间、肾活检结果提示为GN且至少有一个新月体的连续患者。从病历中收集人口统计学细节和临床表现。
共纳入145例患者。平均（标准差）年龄为33.06（11.739）岁。≥50%新月体组咯血发生率显著更高（P = 0.011）。≥50%新月体组快速进展性肾小球肾炎（RPGN）发生率显著更高（P < 0.001）。平均肌酐（P = 0.001）、平均新月体（P < 0.001）和平均尿聚合酶链反应（PCR）（P = 0.031）存在显著差异。≥50%新月体组抗中性粒细胞胞浆抗体（ANCA）相关性血管炎发生率显著更高（P < 0.001）。随着新月体增加，完全缓解率降低。在有新月体的GN中，与纤维细胞性（58.33%）和细胞性新月体（6.25%）相比，纤维性新月体（≥50%）的存在与更高的治疗抵抗率（100%）相关。在≥50%新月体组中，纤维性新月体患者的死亡率显著更高（57.14%）。
发现新月体比例和新月体年龄与肾衰竭风险增加及治疗抵抗显著相关。
