Crescentic Glomerulonephritis: Morphological Study And Its Clinicopathological Correiation

  • Sridevi Bezwada Dept of Histopathology, Apollo Hospital, Chennai, India
  • Tabassum Anjum Dept of Histopathology, Apollo Hospital, Chennai, India
  • Rama Mani Dept of Histopathology, Apollo Hospital, Chennai, India
  • Ashok Parameshwaran Dept of Histopathology, Apollo Hospital, Chennai, India
  • Mitra Gosh Dept of Histopathology, Apollo Hospital, Chennai, India
Keywords: CRESCENTIC GLOMERULONEPHRITIS, FIBRINOID NECROSIS, ENDSTAGE RENALDISEASE, IMMUNOFLUORESCENCE, VASCULITIS

Abstract

Background Extracapillary Proliferative Glomerulonephritis(Crescentic glomerulonephritis), is  usually a clinical emergency, with men being affected twice than women and consists  of   three  main categories  based   on  immunofluoresence and serology. Overall incidence regardless of country of origin is 2 – 5%.Anti – glomerular basement membrane crescentic  glomerulonephritisImmune complex mediated crescentic glomerulonephritisPauci-immune crescentic glomerulonephritisMethods:  Patients diagnosed as  Crescentic glomerulonephritis on percutaneous needle biopsies of kidney in Apollo hospital, Chennai from 1996 to 2010,  age  group from 6  to 74 yrs, with 19 males and 21 females. The mode of presentation, relevant clinical data, laboratory data, histologic features and immunofluorescence patterns are studied  and pathological  features are correlated with clinical outcome.Result: Out of 40 cases diagnosed as crescentic glomerulonephritis,  6 were followed up retrospectively  and 34  prospectively.  4  were categorized as anti-Glomerular  basement membrane , 13 as pauci-immune,, and 23  as immune-complex.Conclusion: Anti-GBM is the most aggressive form of glomerulonephritis with the highest frequency of renal insufficiency and crescent formation at the time of diagnosis as compared to pauci-immune and immune complex crescentic-GN.  Immune complex GN have a much lower frequency of crescent formation and, when crescents are present, they rarely affect 50% or more of glomeruli. Thus this study has clearly shown that even in the absence of electron microscopy a definite aetiological diagnosis can be made with histology and immunoflourescence alone  in cases of extra capillary proliferative GN presenting as a medical emergency with sudden onset of acute renal failure (RPGN) and helps the clinician in the successful management of the patient.D0i:10.21276/aabs.1657

Author Biography

Sridevi Bezwada, Dept of Histopathology, Apollo Hospital, Chennai, India
PATHOLOGY,ASSISTANT PROFESSOR

References

1. J.Charles Jennette. Rapidly progressive crescentic glomerulonephritis. Kidney international : 2003; 63:1164-1177.
2. Cees G.M.Kallenberg, Elisabeth Brouwer, Jan J. Weening, et al. Anti-neutrophil cytoplasmic antibodies: current diagnostic and pathophysiological potential. Kidney international ; 1994;46:1-15.
3. Peir-Haur-Hung, Yen-Ling Chiu, Wei-Chou Lin, et al. Poor Renal Outcome of Antineutrophil Cytoplasmic Antibody Negative Pauci-Immune Glomerulonephritis in Taiwanese. J Formos Med Assoc: 2006: 105(10): 804-812.
4. Jeremy Levy and Charles D. Pusey. Crescentic glomerulonephritis; Oxford text book of clinical nephrology : Oxford university press 2005; 3rd Edition, chapter 3.10; vol 1 : 559-577.
5. Herbert A hauer, ingeborg M.Bajema, Hans C. van Houwelingen, et al. Renal histology in ANCA – associated vasculitis: difference between diagnostic and serologic subgroups. Kidney International; 2002;61:80-89.
6. J . Charles Jennette and Volker Nickeleit. Anto-glomerular basemant membrance glomerulonephritis and goodpasture’s syndrome; Hepinstall’s pathology of the kidney; Lippincott Williams & Wikins publishers, Philadelphia 2007; 6th edition chapter 13; 1:613-641.
7. Malcolm A.Cunningham, Xiao Ru Huang, John P. Dowling, et al. prominence of cell-Mediated immunity effectors on pauci-immune glomerulonephritis J AmSoc Nephrol; 1999:10:499-506.
8. RC Atkins, DJ Nikolic – Paterson, q song, et al. Modulators of crescentic glomerulonephritis JourNal of the amercian socity of nephrology; 1996: 7:2271-2278.
9. Ayman M.karkar, Jennifer Smith, Charles D. Puesy. Prevention and treatment of experimental crescentic glomerulonephritis by blocking tumour necrosis factor –a Nephrol Dial Transplant; 2001; 16:518-524.
10. Jeremy B. Levy, A.Neil Turner, Andrew J.Rees, et al. long-term outcome of Anti- Glomerular basement membrane antibody disese treated with plasma exchange and immunosuppression. Ann Intern Med; 2001;134: 1033-1042.
11. J.Charles Jennette and David B. Thomas. Pauci-Immune and antineutrophil Cytoplasmic autoantibody mediated crescentic glomerulonephritis and vasculitis; Hepinstall’s pathology of the Kidney; Lippincott Williams & wlkins publishers, Philadelphria . 2007: 6th edition , chapter 14; vol 1:643-673.
12. Brian h. Ewert J Charles Jennette and Ronald J.Falk. Anti-myeloperxidase antibodies stimulate neutrophils to damage human endothelial cells. Kidney international ; 1992;41:375-383.
13. Ute Eisenberger, Fadi Fakhouri, Philippe, et al. ANCA-negative pauci-immune renal vasculitis: histology and outcome. Nephrol dial transplant ; 2005; 20:1392-1399.
14. Langford, Carol A, Balow, et al. New insights into the immunopathogenesis and treatment of the kidney. Current opinion in nephrology and Hypertension; may 2003; vol 12(3) :267-272.
15. Judy Savige, David Davies, Ronald J Falk er al. Antineutrophil cytoplasmic antibodies and associated diseases: A review of the clinical and laboratory features. Kidney international; 2000; 57:846-862.
16. Ingeborg M.Bajema, E.Christian hagen, Email de heer, et al. colocatization of ANCA- antigens and fibrinoid necrosis in ANCA – associated vasculitis. Kidney international; 2001;60:2025-2030.
17. Abraham Rutgers, Marjan Slot Pieter Van Paassen, et al. Coexistence of anti-glomerular basement membrance antibodies and myeloperxidase- AQNCAs in crescentic glomerulonephritis. American journal of kidney diseases; august 2005; vol 46, no 2:253-262.
18. Xavier Bosch, Eduard Mirapeix, Josep Font, et al. Anti-myeloperoxidase autoantibosies in patients with necrotizing glomerular and alveolar capillaritis. American journal of kidney disease; September 1992; vol 20, issue 3:231-293.
19. Tabor Nadasdy and Fred G. Sliva. Acute postinfectious Glomerulonephritis and Glomerulonephritis caused by persistent bacterial infection; Hepinstall’s pathology of the kidney, Lippincott Williams & wilkins publishers, phildelphia. 2007; 6th edition ; chapter 8; vol.1.: 322-396.
20. Vincent Audard, Thomas Hellmark, Khalil El Karoui, et al. A 59-kd renal antigen as a new target for rapidly progressive Glomerulonephritis. Amercian journal of kidney diseases; may 2007; vol 49 no 5: 710-716.
21. David R.W. Jayne, Philip D.Marshall, Sally J.Jones et al. Autoantibodies to GBM and neutrophil cytoplasm in rapidly progressive Glomerulonephritis, Kidney international; 1990; 37,965-970.
22. Casper F.M Franssen, Coen A.Stegeman , Cess G.M.Kallenberg, et al. Antiproteninase 3 and Antimyeloperxidase-associated vasculitis. Kidney international; 2000; 57:2195-2206.
23. Kallenberg, Cees G.M, Cohen Tervant et al. Whats new with anti-neutrophil cytoplasmic antibodies: and therapeutic implications. Current opinion in nephrology and Hypertension; May 1999; vol 8 (3): 307-315.
24. E.christiaan hagen, mohanmed r. daha, jo hermans , et al. diagnosis value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculits. Kidney international; 1998;53: 743-753.
25. Ronald J Falk. ANCA-associated renal disease. Kidney international; 1990; 38: 998-1010.
26. H.G.Sieberth and N.Maurin. The therapy of rapidly progressive Glomerulonephritis. Kin Wochenschr; 1983 ; 61: 1001-1010.
27. Joshus F.Zeidner, Edwin J.Ostrin, Emily Sydnor, et al. the tissue’s the issue. The American journal of medicine; may 2010; vol 123, no 5 : 420-422.
28. Penelope P. Kapitsinou. John P.A.Loannidis, John N.Boletis, et al. Clinicopqthologic predicator of death and ESRD in patients with pauci-immune necrotizing Glomerulonephritis. American journal of kidney diseases; January 2003; vol 41,1 : 29-37.
29. Herbert A.Hauer, Ingeborg M.Bajema, Hans C. Van Houwelingen, et al.Determinants of outcome in ANCA-associated Glomerulonephritis: A prospective clinic-histopathological analysis of 96 patients. Kidney international; 2002 ; 63: 1732-1742
30. Clara J Day, Alec J Howie, Peter Nightingle, et al. Predication of ESRD in pauci-immune necrotizing Glomerulonephritis: Quantitative histomorphometric assessment and serum creatinine. American journal of kidney diseases; February 2010; vol 55, no 2:250-258.
Published
2018-03-12
Issue
Vol 5 No 1 (2018)
Section
Original Article

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).