Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]

Background: The spectrum and outcomes of crescentic glomerulonephritis (Cr.GN) in South Asia is vastly different from that reported worldwide and there is a paucity of information. The aim of the study was to study the demography, clinical presentation, histology and predictors of longitudinal outco...

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Main Authors: Suceena Alexander, Sabina Yusuf, Gautham Rajan, Elenjickal Elias John, Sanjeet Roy, VC Annamalai, Athul Thomas, Jeethu Joseph Eapen, Anna T Valson, Vinoi George David, Santosh Varughese
Format: Article
Language:English
Published: Wellcome 2020-07-01
Series:Wellcome Open Research
Online Access:https://wellcomeopenresearch.org/articles/5-164/v1
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spelling doaj-83a79b79837f47e395ed474912d7307b2020-11-25T02:30:53ZengWellcomeWellcome Open Research2398-502X2020-07-01510.12688/wellcomeopenres.16071.117633Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]Suceena Alexander0Sabina Yusuf1Gautham Rajan2Elenjickal Elias John3Sanjeet Roy4VC Annamalai5Athul Thomas6Jeethu Joseph Eapen7Anna T Valson8Vinoi George David9Santosh Varughese10Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of General Pathology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaDepartment of Nephrology, Christian Medical College, Vellore, Tamil Nadu, 632004, IndiaBackground: The spectrum and outcomes of crescentic glomerulonephritis (Cr.GN) in South Asia is vastly different from that reported worldwide and there is a paucity of information. The aim of the study was to study the demography, clinical presentation, histology and predictors of longitudinal outcomes of Cr.GN in this population. Methods: An observational cohort study of renal biopsies was performed in the largest tertiary center in South India over a period of 10 years (January 2006 to December 2015) with ≥50% crescents on renal histology indicating Cr.GN. Results: A total of 8645 kidney biopsies were done; 200 (2.31%) were Cr.GN. Patients were categorized into three etiological groups: anti-glomerular basement membrane (type I), immune complex (type II), and pauci-immune (type III). Type II was the most common (96, 46.5%), followed by type III (73, 38%) and type I (31, 15.5%). Female preponderance was seen across all types. About half of all patients presented with recent onset hypertension. Type II had the highest median proteinuria (4.2 (2.1-6) g/day, p=0.06) and the median estimated glomerular filtration rate was lowest in type I (5 (4-8) ml/min/1.73m2, p<0.001). Among type III, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis was seen only in ~50% of patients. Nearly one third of patients with type I were also positive for ANCA making them ‘double positive’. Acute glomerular insults like tuft necrosis and chronic changes as evidenced by moderate to severe interstitial fibrosis, was a predominant feature of type I. Conclusions: ANCA-negative pauci-immune vasculitis, as well as double positive Cr.GN, are reported for the first time in South-Asia. Renal survival was significantly worse in type I/III compared to type II. Types I/III, moderate to severe interstitial fibrosis and tubular atrophy, presence of oliguria/anuria and increasing percentage of crescents in renal biopsy were significant predictors of end stage kidney disease in our cohort.https://wellcomeopenresearch.org/articles/5-164/v1
collection DOAJ
language English
format Article
sources DOAJ
author Suceena Alexander
Sabina Yusuf
Gautham Rajan
Elenjickal Elias John
Sanjeet Roy
VC Annamalai
Athul Thomas
Jeethu Joseph Eapen
Anna T Valson
Vinoi George David
Santosh Varughese
spellingShingle Suceena Alexander
Sabina Yusuf
Gautham Rajan
Elenjickal Elias John
Sanjeet Roy
VC Annamalai
Athul Thomas
Jeethu Joseph Eapen
Anna T Valson
Vinoi George David
Santosh Varughese
Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
Wellcome Open Research
author_facet Suceena Alexander
Sabina Yusuf
Gautham Rajan
Elenjickal Elias John
Sanjeet Roy
VC Annamalai
Athul Thomas
Jeethu Joseph Eapen
Anna T Valson
Vinoi George David
Santosh Varughese
author_sort Suceena Alexander
title Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
title_short Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
title_full Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
title_fullStr Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
title_full_unstemmed Crescentic glomerulonephritis: what’s different in South Asia? A single center observational cohort study [version 1; peer review: 2 approved]
title_sort crescentic glomerulonephritis: what’s different in south asia? a single center observational cohort study [version 1; peer review: 2 approved]
publisher Wellcome
series Wellcome Open Research
issn 2398-502X
publishDate 2020-07-01
description Background: The spectrum and outcomes of crescentic glomerulonephritis (Cr.GN) in South Asia is vastly different from that reported worldwide and there is a paucity of information. The aim of the study was to study the demography, clinical presentation, histology and predictors of longitudinal outcomes of Cr.GN in this population. Methods: An observational cohort study of renal biopsies was performed in the largest tertiary center in South India over a period of 10 years (January 2006 to December 2015) with ≥50% crescents on renal histology indicating Cr.GN. Results: A total of 8645 kidney biopsies were done; 200 (2.31%) were Cr.GN. Patients were categorized into three etiological groups: anti-glomerular basement membrane (type I), immune complex (type II), and pauci-immune (type III). Type II was the most common (96, 46.5%), followed by type III (73, 38%) and type I (31, 15.5%). Female preponderance was seen across all types. About half of all patients presented with recent onset hypertension. Type II had the highest median proteinuria (4.2 (2.1-6) g/day, p=0.06) and the median estimated glomerular filtration rate was lowest in type I (5 (4-8) ml/min/1.73m2, p<0.001). Among type III, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis was seen only in ~50% of patients. Nearly one third of patients with type I were also positive for ANCA making them ‘double positive’. Acute glomerular insults like tuft necrosis and chronic changes as evidenced by moderate to severe interstitial fibrosis, was a predominant feature of type I. Conclusions: ANCA-negative pauci-immune vasculitis, as well as double positive Cr.GN, are reported for the first time in South-Asia. Renal survival was significantly worse in type I/III compared to type II. Types I/III, moderate to severe interstitial fibrosis and tubular atrophy, presence of oliguria/anuria and increasing percentage of crescents in renal biopsy were significant predictors of end stage kidney disease in our cohort.
url https://wellcomeopenresearch.org/articles/5-164/v1
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