Clinicopathological features and prognostic analysis of 49�cases with crescentic glomerulonephritis

Wu, Ting; Peng, Jiajia; Meng, Ting; Liu, Qianqian; Ao, Xiang; Lin, Wei; Yin, Hang; Chen, Jinbiao; Pu, Jiaxi; Peng, Zhangzhe; Peng, Weilin; Li, Xiaozhao; Xiao, Xiangcheng; Zhou, Qiaoling; Zhong, Yong; Xiao, Ping

doi:10.3892/etm.2019.8023

Cited by 18 publications

(32 citation statements)

References 29 publications

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“…However, we found no cases of low C4 levels in type I and III Cr.GN, highlighting that the alternate complement pathway has a role in the pathogenesis of these GNs. Our observed rates of ANCA seropositivity in type III Cr.GN are much lower than those reported in other studies 2 , 15 . An earlier study from India also reported similar rates of ANCA seropositivity 16 .…”

Section: Discussioncontrasting

confidence: 76%

“…However, in this study, more than half of the patients with type II and III Cr.GN also presented with severe renal failure, highlighting the dramatic presentation in this patient population. These rates are much higher than previously reported 2,15 .…”

Section: Discussioncontrasting

confidence: 71%

“…Gender differences in Cr.GN have mostly been observed in type II Cr.GN with female preponderance. The gender distribution has been variable in type I and type III Cr.GN in different studies 2,11,[13][14][15] . As is already known and established in other studies, patients with type I Cr.GN had the most severe renal failure at presentation.…”

Section: Discussionmentioning

confidence: 99%

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Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study

et al. 2020

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Background: The spectrum and outcomes of crescentic glomerulonephritis (Cr.GN) in South Asia is vastly different from that reported worldwide and there is a paucity of information. The aim of the study was to study the demography, clinical presentation, histology and predictors of longitudinal outcomes of Cr.GN in this population. Methods: An observational cohort study of renal biopsies was performed in the largest tertiary center in South India over a period of 10 years (January 2006 to December 2015) with ≥50% crescents on renal histology indicating Cr.GN. Results: A total of 8645 kidney biopsies were done; 200 (2.31%) were Cr.GN. Patients were categorized into three etiological groups: anti-glomerular basement membrane (type I), immune complex (type II), and pauci-immune (type III). Type II was the most common (96, 46.5%), followed by type III (73, 38%) and type I (31, 15.5%). Female preponderance was seen across all types. About half of all patients presented with recent onset hypertension. Type II had the highest median proteinuria (4.2 (2.1-6) g/day, p=0.06) and the median estimated glomerular filtration rate was lowest in type I (5 (4-8) ml/min/1.73m2, p<0.001). Among type III, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis was seen only in ~50% of patients. Nearly one third of patients with type I were also positive for ANCA making them ‘double positive’. Acute glomerular insults like tuft necrosis and chronic changes as evidenced by moderate to severe interstitial fibrosis, was a predominant feature of type I. Conclusions: ANCA-negative pauci-immune vasculitis, as well as double positive Cr.GN, are reported for the first time in South-Asia. Renal survival was significantly worse in type I/III compared to type II. Types I/III, moderate to severe interstitial fibrosis and tubular atrophy, presence of oliguria/anuria and increasing percentage of crescents in renal biopsy were significant predictors of end stage kidney disease in our cohort.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 71%

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Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study

et al. 2020

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“…Some of the abovementioned features of APN-induced severe AKI seem to resemble other causes of AKI, including AIN, acute tubular necrosis (ATN) and rapidly progressive glomerulonephritis (RPGN). All of these conditions can cause AKI with bilateral kidney enlargement ( 27 , 28 ). The common clinical manifestations of AIN are nonspecific, including asthenia, anorexia, nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review

et al. 2021

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The patient was a 38-year-old man who had experienced nausea and fever for a few days and presented with back pain, oliguria, and pyuria, suggesting acute pyelonephritis (APN). He showed acute kidney injury (AKI) with bilateral kidney enlargement and was using nonsteroidal anti-inflammatory drugs (NSAIDs). AKI-induced by APN was confirmed by kidney biopsy. The AKI was successfully treated with antibiotic therapy. A search of the relevant literature for reports on histopathologically-proven APN-induced severe AKI revealed that the key characteristics were bilateral kidney enlargement with pyuria without casts. Oligoanuria was frequently associated with APN-induced severe AKI, and NSAID use may be a possible risk factor. Prompt antibiotic treatment based on the clinical characteristics of APN-induced AKI can improve the renal outcome.

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“…These rates are much higher than previously reported. 2,15 Serum complement C3 levels have been shown to be low in type I and type III Cr.GN in addition to type II Cr.GN. The same was confirmed in our study.…”

Section: Discussionmentioning

confidence: 99%

Crescentic Glomerulonephritis: What’s different in South Asia? - A Single Center Observational Cohort Study

Schmeißer

Yusuf

Rajan

et al. 2020

Preprint

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Background The spectrum and outcomes of crescentic glomerulonephritis in South Asia is vastly different from that reported worldwide and there is a paucity of information. Methods It was an observational cohort study of renal biopsies done in the largest tertiary center in South India over a period of 10 years with ≥50percentage crescents on histology. Results A total of 8645 kidney biopsies were done at our center from January 2006 to December 2015, and 200 were crescentic glomerulonephritis. Patients were categorized into three etiological groups- anti-GBM (type I), immune complex (type II) and pauci-immune (type III). The most common was type II (96, 46.5percentage), followed by type III (73, 38percentage) and then type I (31, 15.5percentage). Female preponderance was seen across all three types. About half of all the three types presented with recent onset hypertension. Type II had the highest median proteinuria (4.2 (2.1-6) g/day, p=0.06) and the median eGFR was lowest in type I (5 (4-8) ml/min/1.73m2, p<0.001). Among type III, ANCA associated vasculitis (AAV) was seen only in about half of the patients. Nearly one third patients with type I was also positive for ANCA making them double positive. Severe glomerular insults like tuft necrosis and chronicity as evidenced by moderate to severe interstitial fibrosis was a predominant feature of type I. Conclusions ANCA negative vasculitis as well as double positive types are reported for the first time from South-Asia. Prevalence of ANCA negative vasculitis (type III subgroup) was much higher in our population. Renal survival was significantly worse in type I and III compared to type II. Types I or III, moderate to severe IFTA, presence of oliguria or anuria and increasing percentage of crescents in renal biopsy were significant predictors of dialysis dependence at index visit or of end stage kidney disease at follow-up in our cohort.

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Clinicopathological features and prognostic analysis of 49�cases with crescentic glomerulonephritis

Cited by 18 publications

References 29 publications

Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study

Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study

Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review

Crescentic Glomerulonephritis: What’s different in South Asia? - A Single Center Observational Cohort Study

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