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Abstract: PO1607

Clinical Course of Crescentic Glomerulonephritis in Singapore

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Lee, Tung Lin, Singapore General Hospital, Singapore, Singapore
  • Tan, Hui Zhuan, Singapore General Hospital, Singapore, Singapore
  • Mok, Irene Yanjia, Singapore General Hospital, Singapore, Singapore
  • Choo Chon Jun, Jason, Singapore General Hospital, Singapore, Singapore
  • Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, Singapore
Background

Crescentic Glomerulonephritis (GN) is histologically representative of severe glomerular damage, and commonly manifests as rapidly progressive glomerulonephritis (RPGN). We report our center’s experience with Crescentic GN over a 5 year period.

Methods

Retrospective cohort study of biopsy-proven glomerulonephritis with ≥10% crescents diagnosed between November 2015 and January 2021 in an academic medical center nephrology unit. Primary outcome was time to death or end stage renal failure (ESRF).

Results

We evaluated 50 patients (36% male), median age 64.7 years (IQR 51.2, 72.4) with crescents in 37.5% (17.4, 54.3) of the glomeruli sampled. At presentation, 70% had acute kidney injury with median serum creatinine 278 (118, 537) µmol/L and 26% required dialysis. The most frequent diagnoses were pauci-immune GN including ANCA-associated vasculitis (70%), lupus nephritis (14%), IgA nephropathy (10%) and anti-GBM disease (4%).
At 6 months, the majority (94%) had received immunosuppressants including methylprednisolone (66%), prednisolone (88%), cyclophosphamide (70%), rituximab (12%), mycophenolate mofetil (36%) and plasma exchange (30%). Remission was achieved in 44%.
Median follow up was 29.5 (19.8, 48.2) months. End Stage Renal Failure (ESRF) occurred in 32% at 0 (0, 2) months and death occurred in 18% at 5 (1, 23) months. ESRF and/or death occurred in 22 patients (44%). Survival was best for lupus nephritis (log rank p = 0.03) among the most common diagnoses (Figure 1). Multi-variable analysis (stepwise) found that pre-biopsy serum creatinine was independently associated with the primary outcome (HR 1.02, 95% CI 1.01–1.03 per 10 µmol/L increase) after adjusting for age, diabetes, crescents and histological diagnosis.

Conclusion

Despite the majority of patients receiving treatment, a significant proportion (44%) still reached the primary outcome of death and ESRF. Novel and efficacious treatment options are therefore needed to improve the outcomes and prognosis of patients with such a debilitative condition.