Two distinct types of crescentic glomerulonephritis
Takeda, S.; Kida, H.; Yokoyama, H.; Tomosugi, N.; Kobayashi, K.
Clinical Nephrology 37(6): 285-293
1992
ISSN/ISBN: 0301-0430 PMID: 1638779 Document Number: 403633
For a characterization of the clinical course of crescentic glomerulonephritis (Cres. GN), reciprocals of serum creatinine concentration (1/Cr) as a function of time were studied in 24 patients. The patients fulfilled the following criteria. Crescents were observed in more than 50% of glomeruli, and the increment of serum creatinine could be determined sequentially on three occasions in the phase of progression of renal impairment. In all patients 1/Cr declined linearly with time with correlation coefficients between 0.881 and 0.993. According to the slope, the patients were divided into two groups; an acute group (13 patients) with slopes of -1.0 .times. 10-2 dl/mg/day or more steep, i.e., with increments of serum creatinine from 1.0 to 10.0 mg/dl within 90 days, and a subacute group (11 patients) with less steep slopes. Histologically, there was no difference in the percentage of glomeruli with crescents between the two groups. However, in the acute group a negative correlation was found between the period from onset to hisological examination and the percentage of glomeruli with cellular crescents in all glomeruli with various crescents (r = -0.872, p < 0.001), while in the subacute group the percentage was nearly constant regardless of the time of histological examination. These mean drastic but transient activation of the disease in the former in spite of persistance of indolent activity in the latter. Clinically, in the acute group an improvement of serum creatinine was observed in 8 (61.5%) vs. only 2 (18.2%) in the subacute group (p < 0.05). These results indicated that according to the slope of 1/Cr, Cres. GN could be divided into acute and subacute groups; the former may follow a favorable course in spite of rapid deterioration of renal function in the initial phase, while the latter may show slow but steady deterioration of renal function. This differentiation, attributable to the mode of crescent formation, could be of great value for clinical use.