Abstract
Background: Crescents indicate active disease with rapidly deteriorating renal function. Many primary renal diseases can be associated with crescents, however only a few conditions presents as crescentic glomerulonephritis (CrGN). The incidence varies in different population. Aims and objective: The aim of the study was to know the incidence of CrGN and that of crescents in various glomerulopathies along with their clinicopathological associations. Material and methods: Renal core biopsies over 5 year period were collected retrospectively from pathology archives and reviewed for crescents and CrGN. Clinical, serological, Immunoflourescence and follow up details were collected. Results: A total of 1629 renal biopsies were received. Crescents were identified in 9.69% and 2.08% were CrGN. Males and females were equally distributed. Paediatric population constituted 24%. The most common presentation was nephritic syndrome. Cellular crescents were seen in 81 cases, fibro cellular/ fibrous in 55 cases and both in 22 cases. In immune complex(IC) mediated group, lupus nephritis (LN) showed crescents in 31.7%, followed by PIGN (29.67%) and IgAN (25.2%). Vasculitis group had 79% crescents. All cases of anti GBM disease and pauci immune ANCA negative renal limited vasculitis (PI-RLV) had crescents. The most common CrGNs were anti GBM disease (100%), followed by vasculitis (37%) and PI-RLV (33%) and least in IC group (5% in PIGN and IgAN and 3.5% in LN). Complete remission was seen in 32.2%. Conclusion: Crescents in renal biopsies are not rare. Although CrGN is more common in vasculitis and anti-GBM disease, the incidence of IC-GN is more in our population and a significant number may show crescents.
Highlights
Crescents in renal biopsy indicate an active disease
Crescents were identified in 158 patients (9.69%), of which 34 (2.08%) were classified as Crescentic glomerulonephritis (CrGN)
Crescents can be seen in the different forms of glomerulonephritis which can be broadly classified into three groups: immune-complex mediated glomerulonephritis, vasculitis and anti-glomerular basement membrane (GBM) antibody disease [4]
Summary
Crescents in renal biopsy indicate an active disease. It is the most common biopsy diagnosis which clinically presents as rapidly progressive renal failure. CrGN is a well-studied entity, the clinicopathological spectrum of the glomerular disease associated with crescents in renal biopsies has not been presented in detail in the literature from India, with sparse data from South India. All cases of anti GBM disease and pauci immune ANCA negative renal limited vasculitis (PI-RLV) had crescents. The most common CrGNs were anti GBM disease (100%), followed by vasculitis (37%) and PI-RLV (33%) and least in IC group (5% in PIGN and IgAN and 3.5% in LN). CrGN is more common in vasculitis and antiGBM disease, the incidence of IC-GN is more in our population and a significant number may show crescents
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