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Abstract: PO1947

Rituximab vs. Cyclophosphamide in the Treatment of Anti-GBM Crescentic Glomerulonephritis: An Observational Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Jaryal, Ajay, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Vikrant, Sanjay, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Background

Anti glomerular basement membrane (GBM) crescentic glomerulonephritis (CsGN) is a rare disease affecting kidneys and/or lungs. At present most of the evidence for its treatment is with use of plasmapheresis (PP), high dose steroids (HDS) and cyclophosphamide (CYC). The use of Rituximab (Rtx) in addition to PP and HDS is only anecdotal. Herein, we are describing our experience with the use of both the regimens.

Methods

A retrospective analysis of all the patients with anti GBM CsGN admitted in our hospital from September 2018 to November 2019 was done. Anti GBM CsGN was diagnosed on the basis of ≥50% crescents on kidney biopsy and immunofluoroscence showing linear IgG deposition along GBM and/or by the presence of anti GBM antibodies.

Results

11 patients were admitted with anti GBM CsGN, during this period (15 months). Kidney biopsy was done in 10 patients and in one anti GBM GN was diagnosed on the basis of raised anti GBM antibody titres. There were 8 females and three males (age range 37-72 years). The mean serum creatinine was 8.69mg/dl. Out of 11 patients 2 refused for treatment and 2 were lost to follow up. 3 out of 7 patients had diffuse alveolar hemorrhage (DAH) and in all it succeeded renal involvement (one had diagnosis of usual interstitial pneumonia for 1 year). 4 out of 11 patients had concomitant urinary tract infection, 5 out of 7 (71.42%) were ANCA positive, 2 out 11 had type 2 diabetes mellitus, 5 out of 11 were oligoanuric and 7/11 (63.6%) were dialysis requiring at presentation. PP was given on alternate days. Both the patients who refused for treatment died on follow up. Among remaining 7 patients 5 had received PP+HDS + CYC and 2 had received PP+HDS+Rtx. In CYC group 4 (all 4 were dialysis dependent and 3 were oligoanuric) out of 5 patients died whereas in Rtx group both the patients survived (one was dialysis dependent and oligoanuric).

Conclusion


In our study most of the patients presented late to the hospital due to vague symptoms at the onset (mean 30 days) and few had co-existing UTI (this delayed the treatment). 63.6 % were dialysis requiring at presentation and DAH was the most common cause of in-hospital death. Two out the three survivors achieved normal eGFR (one in CYC and one in Rtx arm) whereas third one had no progressive decline in eGFR (Rtx). The use of Rtx along with HDS and PP showed favourable outcomes in our study.