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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 FWK; Tarzi RM; Levy JB; Griffith M; Lightstone L; Cook HT; Cairns T; Pusey CD
  • Rheumatology (Oxford) 2015[Jun]; 54 (6): 1025-32 PMID25431483show 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.
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