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• W2955282666 abstract "Rapidly progressive glomerulonephritis (RPGN) is a rare and fatal disease with varied prevalence in different regions and ethnicities. This prospective study was conducted in our medical college hospital in North India during January 2015 to March 2016. All patients admitted in the department of nephrology with rapidly progressive glomerulonephritis were included. A written informed consult was taken in each case. The diagnosis of RPGN was based on renal biopsy showing crescents in >50% of glomeruli and classification based on Immunofluorescence findings. Patients were followed up for 6 months. Primary outcomes included response to treatment and secondary outcomes included complications to treatment or disease per se. Forty-three patients (25 male and 18 female) with mean age of 46.4± 16.3 years were recruited. Three patients were lost to follow-up and 40 included in the study. Clinical profile at entry showed: mean duration of symptoms before diagnosis 37.1±38.3 days, oliguria and pedal edema (55%), hematuria (15%), hypertension (32.5%), mean serum creatinine (9.1±4.7 mg/dl), eGFR (9.34±9.0 ml/mt.) and proteinuria (2.7±2.1 g/day). Thirty-one patients needed renal replacement therapy at diagnosis. Histopathological parameters included: mean value of number of glomeruli in biopsy samples (18±9.7), sclerosed glomeruli (27.2±21.4%) and crescents in 70.4±17.5% (cellular 52.5±32.2%, fibro cellular 32.1± 27.2%, fibrous 16.1±24.2%), interstitial infiltrate in 45% and Interstitial fibrosis and tubular atrophy in 50%. Pauci-immune RPGN was seen in 23 (57,5%), followed by Immune complex mediated in 10 (25%) and Anti GBM in 7 (17.5%) cases. Pauci-immune RPGN included 10(43.5%) patients with MPO-ANCA, 6(26.1%) patients with PR3-ANCA, 2(8.7%) patients with both MPO and PR3 positive and 5(21.7%) patients with negative ANCA. Of the 7 cases of anti GBM RPGN, 4 were ANCA positive (MPO in 3 and PR3 in one). Primary outcomes were complete remission in 5(12.5%), partial remission in 9(22.5%) and no response in 26(65%) of patients. Entry serum creatinine (<5.5 mg/dl complete remission p=0.001 and >5.5 mg/dl no remission p=0.003), entry eGFR (complete remission p=0.025, partial remission p=0.024 and no remission p=0.049), renal replacement therapy on admission (not required in 80% with complete remission p=0.001, required in all cases with no remission p=0.001 and death p=0.049), interstitial fibrosis (absent in 79% with complete remission p=0.017, significant fibrosis in 61% of non-responders p=0.049), tubular atrophy (partial remission p=0.039 and no response p=0.026) and interstitial infiltrates (mild infiltrates in 71% with complete remission p=0.001, moderate to severe infiltrate in partial remission p=0.048 and in no response p=0.001) correlated with primary outcomes. In secondary outcomes, infections were the most common (55%) followed by neutropenia (40%). Infections correlated with mortality (p=0.050). Ten patients (25%) died during study period. Causes of mortality were: infections (50%), cardiovascular (30%), stroke (10%) and undetermined in 10% cases. Rapidly progressive glomerulonephritis is not uncommon. Pauci-immune RPGN is the commonest form followed by immune-complex mediated and anti-GBM disease. Entry serum creatinine and eGFR, IFTA on renal histology and requirement of renal replacement therapy predicted the outcomes." @default.
• W2955282666 created "2019-07-12" @default.
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• W2955282666 date "2019-07-01" @default.
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• W2955282666 title "MON-044 PREDICTION OF OUTCOMES OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS" @default.
• W2955282666 doi "https://doi.org/10.1016/j.ekir.2019.05.831" @default.
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