Clinicopathological and Prognostic Study in Patients with Crescentic Glomerulonephritis: A Thirteen Year Single Center Experience

Abstract

Objectives: Various risk factors associated with crescentic glomerulonephritis (CGN) prognosis have been reported, but there is no definitive consensus for prognostic predictors of kidney outcome. We aimed to investigate the factors associated with developing end-stage kidney disease (ESKD) in CGN patients. Materials and Methods: Over 13 years, we retrospectively evaluated kidney biopsy results, clinical, and laboratory data of patients diagnosed with CGN at our center. The relationships between potential predictors and kidney outcomes were investigated. Results: We analyzed 91 patients diagnosed with CGN. The mean age was 46.4±17.4 years, and 59% were male. Over a median follow-up of 17 months, 34 (37%) patients resulted in ESKD, and 12 (13%) patients died. Cox regression analysis showed that the serum creatinine level was above 3 mg/dL at the time of diagnosis, requirement for dialysis, presence of more than 24% globally sclerotic glomeruli on kidney biopsy, and >25% interstitial fibrosis and tubular atrophy (IFTA) score were found to be associated with ESKD. On multivariate analysis, need for dialysis [hazard ratio (HR): 2.4, 95% confidence interval (CI): 1.06-5.40, p=0.034], the serum creatinine level >3 mg/dL (HR: 2.92, 95% CI: 1.05-8.10, p=0.040), and IFTA score >25% (HR: 2.85, 95% CI: 1.31-6.20, p=0.008) were independent risk factors for the development of ESKD. Conclusion: Chronic changes in kidney biopsy and the severity of kidney function impairment provide helpful information for predicting kidney outcomes in patients with CGN. Early diagnosis and appropriate therapy are of the utmost importance to improve the prognosis of patients with CGN.

Keywords

• Crescentic glomerulonephritis
• end-stage kidney disease
• kidney biopsy
• risk factors

Kresentik Glomerülonefritli Hastalarda Klinikopatolojik ve Prognostik Çalışma: On Üç Yıllık Tek Merkez Deneyimi

Abstract

Amaç: Kresentik glomerülonefrit (KGN) prognozu ile ilişkili çeşitli risk faktörleri bildirilmiş olsa da, böbrek sağkalımı prognostik beliryecileri için kesin bir fikir birliği yoktur. KGN hastalarında gelişen son dönem böbrek hastalığı (SDBH) ile ilişkili faktörleri araştırmayı amaçladık. Gereç ve Yöntem: On üç yılı aşkın bir sürede merkezimizde KGN tanısı alan hastaların böbrek biyopsi sonuçlarını, klinik ve laboratuvar verilerini retrospektif olarak değerlendirdik. Potansiyel belirleyiciler ile böbrek sonuçları arasındaki ilişkileri araştırdık. Bulgular: KGN tanısı alan 91 hastayı inceledik. Yaş ortalaması 46,4±17,4 yıl olup, %59’u erkekti. On yedi aylık medyan takip süresi boyunca, 34 (%37) hasta SDBH ile sonuçlandı ve 12 (%13) hasta öldü. Cox regresyon analizinde, tanı anında serum kreatinin düzeyinin 3 mg/dL’nin üzeri, diyalizgereksinimi varlığı, böbrek biyopsisinde global sklerotik glomerül oranının >%24 ve interstisyel fibrozis ve tübüler atrofi (IFTA) skorunun >%25 olmasının SDBH ile ilişkili olduğu bulundu. Çok değişkenli analizde, diyaliz gereksinimi [risk oranı (HR): 2,4, %95 güven aralığı (GA): 1,06-5,40, p=0,034), serum kreatinin düzeyinin >3 mg/dL (HR: 2,92, %95 GA: 1,05-8,10, p=0,040) ve IFTA skorunun >%25 (HR: 2,85, %95 GA: 1,31-6,20, p=0,008) olması SDBH gelişimi için bağımsız risk faktörleriydi. Sonuç: Böbrek biyopsisindeki kronik değişiklikler ve böbrek fonksiyon bozukluğunun şiddeti, KGN’li hastalarda böbrek sonuçlarını öngörmede yardımcı bilgiler sağlar. KGN’li hastaların prognozunu iyileştirmek için erken tanı ve uygun tedavi son derece önemlidir.

Keywords

• Kresentik glomerülonefrit
• son dönem böbrek hastalığı
• böbrek biyopsisi
• risk faktörleri

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