Post-infectious glomerulonephritis with crescents in adults: a retrospective study

Abstract

BackgroundCrescent 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.MethodsBiopsy 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.ResultsSix 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 m2 (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 m2) 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.ConclusionNon-streptococcal infections are more common precipitants. There was no correlation between histological and clinical severity. Patients treated with steroids had better renal outcomes.

Efficacy of Corticosteroids in Infection-Related Glomerulonephritis–A Randomized Controlled Trial

“…6 Similar conclusions were drawn from an older study with a similar-sized cohort ( n = 52). 7 Nevertheless, multiple case reports 4 , 8 , 9 and some observational data 3 do suggest a potential benefit from steroids.…”

“…Existing data on the role of steroids have been scarce and observational. 2 , 3 , 4 In this study, we report the results of a randomized controlled trial that studied the effect of steroid therapy on renal outcomes in adults presenting with IRGN and a decreased estimated glomerular filtration rate.…”

Postinfectious Glomerulonephritis with Crescents in an Elderly Diabetic Patient after Acute Gastroenteritis: Case Report

“…There is conflicting evidence supporting the use of steroids. Some studies showed good response, but in some studies, no correlation was found between the steroid use and outcome [6, 7, 8, 9]. Here, we report a case of an elderly diabetic male who developed PIGN with crescents after acute gastroenteritis and responded very well to steroids.…”

“…Crescentic glomerulonephritis having an underlying immune complex proliferative glomerulonephritis is less responsive to aggressive immunosuppressive therapy as compared to anti-glomerular basement membrane or antineutrophil cytoplasmic antibody crescentic glomerulonephritis but for the minority of patients who have idiopathic immune complex crescentic glomerulonephritis, the most common treatment is immunosuppressive therapy with pulse methylprednisolone, followed by prednisone at a dosage of 1 mg/kg daily tapered over the second to third month to an alternate-day regimen until completely discontinued [13]. Baikunje et al [9] studied PIGN with crescents in adults and observed that those patients who were treated with steroids had excellent response, but the duration of therapy was variable. Our patient initially was on hemodialysis but after 2 weeks of steroid therapy hemodialysis was stopped.…”

Role of Steroids in Post-streptococcal Glomerulonephritis Without Crescents on Renal Biopsy

“…The use of immunosuppressive therapy in PSGN has been controversial [ 3 , 8 ]. Several studies have suggested the benefit of steroids in selected patients, but the exact mechanism is not clear [ 9 - 10 ]. The current expert consensus is to use steroids in patients with more than 30% crescents formation on renal biopsy.…”