ISSN: 2642-6145
Authors: Islam Jaynul SM*, Chowdhury NU, Chowdhury AA, Haque WS and Giti S
Background: Diffuse Crescentic glomerulonephritis (CrGN) is defined as presence of crescents in >50% of glomeruli sampled for renal biopsy. This is a critical diagnosis with clinical implications that ideally is communicated to the referring physician immediately. There is limited data on the etiology, clinical and histopathological spectrum of CrGN in Bangladeshi population. Aim: This study aims to identify the aetiology, clinico-pathological features and immunohistological patterns of crescentic glomerulonephritis in Bangladeshi population. Materials and Methods: All the crescentic glomerulonephritis diagnosed histologically at Armed Forces Institute of Pathology, Dhaka irrespective of age and sex are included in the study. The study duration was from January 2017 to December 2018. The renal biopsy samples were undergone H&E, PAS, Masson trichrome and Methanamine silver staining. For each case direct immunofluoresnece study was carried out for IgG, IgM, IgA, C3, C1q, Kappa and Lambda. Depending on clinical, biochemical, serological, histological and immunofluorescence evaluation crescentic glomerulonephritis was classified. Results: During stipulated period 43 crescentic glomerulonephritis were diagnosed which comprises 3.5% out of total 1229 non transplant renal core biopsy patients. Mean age was 30.32+ 17.41 the largest age group (15/43) being paediatric age group (<16 yrs). The male female ratio was 0.72. The most common presentation was generalized body swelling (46.51%) followed by gross haematuria (27.9%). On urine examination 38 (88.37%) patients had haematuria and 28 (65.12%), patients had massive proteinuria (>3.0 Gm/24 hrs). The mean serum creatinine level was 5.9±4.47 mg/dl (1.3 to 18.85 mg/dl). ANA was positive in 5 cases and among those 04 were anti dsDNA positive and labeled as systemic lupus erythematosus (SLE). Among all immune complex mediated crescentic glomerulonephritis (IC-CGN) was 22 (51.16%), Pauci-immune crescentic glomerulonephritis (PI-CGN) was 17 (39.53%), anti-glomerular basement membrane disease (anti GBM disease) was 03 (6.97%) and 01(4%) could not be classified due to lack of DIF findings. Average age of IC-CrGN is 27.86 yrs, PI-CrGN is 31.29 yrs and anti GBM disease is 36.67 yrs. Serum creatinine level during admission was in average, 4.10 mg/dl in IC-CrGN, 5.66 mg/dl in PI-CrGN and 11.46 mg/dl in anti GBM disease. Among the PI-CGN, 9 (53%) were ANCA positive and 08 (47%) were ANCA negative. Among ANCA positive PI-CGN, one had associated ANA positivity. One IC-CrGN case found with associated with ANCA positivity. Among 22 IC-CGN, 05 (23%) were crescentic IgA, 04 (18%) were crescentic lupus nephritis, 04 (18%) were C3 glomerulopathy, 09 (41%) were post infectious glomerulonephritis with diffuse crescent formation. The glomerular crescents formation was (79.4%±14.13) in PI-CGN while it was (67.62%±13.98) among IC-CGN cases and (79.89%±17.7) in anti GBM glomerulonephritis. Among ICCGN, 7 (31.81%) cases needed dialysis on admission, while 9 (52.94%) PI-CGN cases and all (100%) anti GBM cases were managed during admission by dialysis. Conclusion: Diffuse CrGN is not very rare in our population which warrants early notification to the clinician for its aggressive prognostic significance. IC-CrGN accounts for commonest immunohistological pattern of CrGN in our cohort followed by PI-CrGN and anti GBM diseases.
Keywords: Crescentic glomerulonephritis; Haematuria; Glomerulopathy; Interstitium; Aetiology; Creatinine; Proteinuria; Glomeruli
