PATHOLOGY AND RENAL OUTCOME OF THREE UNCOMMON FACES OF CRESCENTRIC GLOMERULONEPHRITIS

Abstract

AIMS: Rapidly progressive glomerulonephritis (RPGN) presents with rapidly deteriorating renal function (> 50% loss of glomerular ltration rate /GFR within 3 months) associated with nephritic urinary sediments and crescents in biopsy. Crescentric IgA Nephropathy, Anti-GBM (Glomerular basement membrane) disease and combined IgA Nephropathy with Anti-GBM disease are three uncommon reasons of RPGN. We have compared clinicopathological. Immunouorescence (DIF) and renal outcome of three groups. Setting and designs: Prospective, cross-sectional, single centre study. METHODS AND MATERIALS :Ultrasonography guided core biopsies obtained, one stained with hematoxylin-eosin, periodic acid-Schiff, Masson's trichrome, and silver methenamine stain another one with immunouorescence conjugated IgG, IgM, IgA, C3, C1q, kappa and lambda stain. Demographic, clinicopathological and therapeutic parameters with survival data were collected. STATISTICAL ANALYSIS USED: Done using software (GraphPad PRISM 6). RESULTS: We have included 9 cases of crescentric IgA Nephropathies, 6 cases of AntiGBM diseases and 2 cases of combined IgA Nephropathy and AntiGBM diseases. Signicant difference seen in the incidences of hypertension, hemoptysis, serum creatinine, anti GBM antibody, total number of crescents and mesangial hypercellularity, fragmentation of GBM etc. IgG, IgA and kappa positivity in DIF show signicant difference. Survival analysis and mortality versus dialysis dependence and complete and partial remission versus no remission showed no difference between these three groups. CONCLUSIONS: Proper and early clinicopathological diagnosis is important since all are of poor renal outcome. Further renal outcome of the combined disease is same as that of individual ones.