Abstract: FR-PO0758
More Than Crescents: Renal Recovery in a Dialysis-Dependent Patient with Immune-Complex Crescentic Glomerulonephritis (GN) with an Overlapping Phenotype
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Reyes-Jimenez, Carmen Johanna, Hospital Menonita de Cayey, Cayey, Puerto Rico
- Torres-Rivera, Gabriel J., Hospital Menonita de Cayey, Cayey, Puerto Rico
Introduction
Crescentic glomerulonephritis has a poor prognosis, with half of survivors progressing to ESKD. Although initial hemodialysis dependence is strong predictor of poor outcomes, it may overestimate the irreversibility of renal injury when acute inflammatory lesions predominate over chromic parenchymal damage.
Case Description
50-year-old male with a history of SLE (stable on hydroxychloroquine), hypertension, and type 2 diabetes presented with nausea, vomiting, lower extremity purpura, and a rapid decline in renal function. His serum creatinine (sCr) worsened from a 1.05 mg/dL baseline to 2.31 mg/dL within one month and rapidly progressed to HD dependence at admission. Serologic workup, including anti-dsDNA, ANCA (PR3/MPO), and complement levels (C3, C4), was normal. Protein dyscrasia workup, anti-proteinase and anti-myeloperoxidase, were negative.
Given suspected rapidly progressive glomerulonephritis (RPGN), pulse IV methylprednisolone (500 mg/day for 3 days) was initiated. A kidney biopsy revealed an undifferentiated immune-complex GN with an overlapping phenotype. Light microscopy showed cellular crescents in 13/27 glomeruli, acute tubular injury, and mild vascular changes, with limited chronicity (13% global glomerulosclerosis and 25% interstitial fibrosis/tubular atrophy). Immunofluorescence showed mesangial IgA, C3, C1q, kappa, and lambda deposits. Constellation of findings lacked the typical "full-house" pattern of Lupus Nephritis, raising suspicion for IgA nephropathy or a superimposed pauci-immune
glomerulonephritis. Aggressive induction therapy with Cyclophosphamide (150 mg/d), high-dose Prednisone, and mycophenolate mofetil (500 mg BID) given, while continuing Hydroxychloroquine. After three months of HD and immunosuppression, he had significant renal recovery, allowing discontinuation of dialysis.
Discussion
This case illustrates the "severity vs. chronicity" paradox in RPGN. Overlapping histological features highlight a GN phenotype that responded to aggressive cyclophosphamide therapy. Treating the crescent pattern is more important than a definitive diagnostic label. Initial functional severity may overestimate irreversibility when acute inflammatory lesions predominate over chronic parenchymal damage. Aggressive evaluation and management should continue even after dialysis initiation, as meaningful renal recovery may still occur.