HISTOPATHOLOGICAL CHARACTERISTICS OF CRESCENTIC GLOMERULONEPHRITIS IN PATIENTS WITH RAPIDLY PROGRESSIVE RENAL FAILURE

Abstract

Objectives: Rapid progressive renal failure (RPRF), characterized by rapid loss of kidney function over a few weeks, is a clinical syndrome caused by a wide variety of diseases. Rapidly progressive glomerulitis or crescentic glomerulitis (more than 50% glomeruli affected) is the most frequent lesion causing RPRF. Establishing the etiology diagnosis and the morphology findings of the crescence is essential for proper therapy and predicting outcome. Our goal was to establish the frequency, the etiologies and the histopathology patterns of crescentic lesions in RPRF patients.

Methods: A cross-sectional, descriptive, case series study was conducted at the Anatomical Pathology Department, Gia Dinh People Hospital, observing the pathological findings of the RPRF patients’ kidney biopsies from January 2015 to December 2020.

Results: From 184 eligible kidney biopsies, we found 23 crescentic glomerulitis (12.5%). The major cause (91,4%) was immune complex glomerulonephritis (GN). In which the most common diagnosis was lupus nephritis (65.2%), the following (17.4%) was IgA nephropathy (IgAN). Lupus nephritis presents all three types of crescentic lesions: cellular crescents, fibrocellular crescents, and fibrous crescents, with median values of 27.6%, 25%, and 7%, respectively; with 46.7% of patients presented with all three types of crescents. IgA nephropathy presents only cellular and fibrocellular crescents, with median values of 59% and 12%, respectively; with 50% of patients presented with two types of crescents. Fibrinoid necrosis is present in 100% of underlying etiologies.

Conclusion: Crescentic GN accounts for 12.5% of RPRF cases, primarily due to immune complex-mediated GN, with lupus and IgA nephropathy being the most common causes. All patients (100%) exhibited fibrinoid necrosis. The distribution and combination of crescent types varies among the different etiological groups. The crescentic lesions include all three morphological types, corresponding to disease progression.

Keywords: cellular crescent; fibrocellular crescent; fibrous crescent; rapidly progressive renal failure