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10.1093/rheumatology/keu445

http://scihub22266oqcxt.onion/10.1093/rheumatology/keu445
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suck abstract from ncbi


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pmid25431483
      Rheumatology+(Oxford) 2015 ; 54 (6 ): 1025-32
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  • Necrotizing and crescentic glomerulonephritis presenting with preserved renal function in patients with underlying multisystem autoimmune disease: a retrospective case series #MMPMID25431483
  • McAdoo SP ; Tanna A ; Randone O ; Tam FW ; Tarzi RM ; Levy JB ; Griffith M ; Lightstone L ; Cook HT ; Cairns T ; Pusey CD
  • Rheumatology (Oxford) 2015[Jun]; 54 (6 ): 1025-32 PMID25431483 show ga
  • OBJECTIVE: Necrotizing and crescentic GN usually presents with rapidly declining renal function, often in association with multisystem autoimmune disease, with a poor outcome if left untreated. We aimed to describe the features of patients who have presented with these histopathological findings but minimal disturbance of renal function. METHODS: We conducted a retrospective review (1995-2011) of all adult patients with native renal biopsy-proven necrotizing or crescentic GN and normal serum creatinine (<120 ?mol/l) at our centre. RESULTS: Thirty-eight patients were identified. The median creatinine at presentation was 84 ?mol/l and the median proportion of glomeruli affected by necrosis or crescents was 32%. Clinicopathological diagnoses were ANCA-associated GN (74%), LN (18%), anti-GBM disease (5%) and HScP (3%). Only 18% of cases had pre-existing diagnoses of underlying multisystem autoimmune disease, although the majority (89%) had extra-renal manifestations accompanying the renal diagnosis. All patients received immunosuppression and most had good long-term renal outcomes (median duration of follow-up 50 months), although two progressed to end-stage renal disease within 3 years. We estimate that renal biopsy had an important influence on treatment decisions in 82% of cases. CONCLUSION: Necrotizing and crescentic GN may present in patients with no or only minor disturbance of renal function. This often occurs in patients with underlying systemic autoimmune disease; early referral for biopsy may affect management and improve long-term outcomes in these cases.
  • |Adolescent [MESH]
  • |Adult [MESH]
  • |Aged [MESH]
  • |Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications/drug therapy/*pathology [MESH]
  • |Biopsy [MESH]
  • |Creatinine/blood [MESH]
  • |Female [MESH]
  • |Glomerulonephritis/complications/drug therapy/*pathology [MESH]
  • |Humans [MESH]
  • |Immunosuppression Therapy [MESH]
  • |Immunosuppressive Agents/therapeutic use [MESH]
  • |Kidney Failure, Chronic/prevention & control [MESH]
  • |Kidney Glomerulus/*pathology [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Necrosis/pathology [MESH]
  • |Prognosis [MESH]
  • |Retrospective Studies [MESH]


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