| Objective:To analyze the Clinicopathologic and long-term prognosis of crescentic glomerulonephritis(crescentic GN)and explore the risk factors affecting long-term prognosis of crescentic GN.Methods:Fifty-five patients with crescentic GN treated in the Department of Nephrology,the Second Hospital Affiliated to Shanxi Medical University(Shanxi,China)between 2014 and 2020 were retrospectively analyzed.They were classified into 3types according to immunopathology: Type I crescentic GN is defined as a linear deposition of immunoglobulins along the glomerular basement membrane(GBM);type Ⅱ crescentic GN is defined as glomerular immune complex deposition;and typeⅢ crescentic GN is defined as glomerular pauci-immune deposition.Independent risk factors affecting the rate of glomerular filtration rate(GFR)were analyzed by univariate and multifactorial linear regression analysis,and independent risk factors affecting the long-term prognosis of crescentic GN patients were analyzed by univariate and multifactorial Cox proportional hazards models,and survival curves were drawn for patients with type 3 crescentic GN.Data were analyzed with SPSS26.0 statistical software,and P < 0.05 was considered a statistically significant difference.Results:1.A total of 55 patients with biopsy-proven crescentic GN diagnosed accounting for 2.45%.The composition of patients with type Ⅰ crescentic GN,type Ⅱ crescentic GN and type Ⅲ crescentic GN were 18.18%(10/55),32.73%(18/55)and 49.09%(27/55),respectively.The mean age of all CrGN patients was 52.02 years,the mean age of patients with type Ⅰ crescentic GN,type Ⅱ crescentic GN patients and type Ⅲ crescentic GN were 39 years,44.56 years and 61.8 years,respectively.The difference between the mean age of type Ⅲ crescentic GN and the mean age of type I crescentic GN and type Ⅱ crescentic GN was statistically significant.2.The median baseline creatinine was 397 μmol/L in patients with crescentic GN.The median baseline creatinine of patients with type Ⅰ crescentic GN,type Ⅱ crescentic GN and type Ⅲ crescentic GN were 621.5μmol/L,231 μmol/L and 408μmol/L,respectively,with statistically significant differences between type Ⅱ crescentic GN and type Ⅰ crescentic GN.The detection rate of serum anti-GBM antibody was 100% in type Ⅰ crescentic GN patients and 7.4% in type Ⅲ crescentic GN,and the difference between the two groups was statistically significant.The detection rate of MPO-ANCA of patients with type Ⅰ crescentic GN,type Ⅱcrescentic GN and type Ⅲ crescentic GN were 10%,11.1% and 88.9%,respectively,and the detection rate was higher in type Ⅲ crescentic GN than in type Ⅰ crescentic GN and type Ⅱ crescentic GN,and the difference was statistically significant.The detection rate of MPO-ANCA in patients with type Ⅰ crescentic GN,type Ⅱcrescentic GN and type Ⅲ crescentic GN were 0%,0% and 3.7%,respectively,and the differences between the types were not statistically significant.3.The mean overall percentages of glomeruli with crescents was 76.73% in patients with crescentic GN.The mean overall percentages of glomeruli with crescents of patients with type Ⅰ,type Ⅱ and type Ⅲ crescentic GN were 84.1%,68.18% and 79.57%,with a statistically significant difference between type Ⅰ crescentic GN and type Ⅱ crescentic GN.The mean percentage of glomeruli with cellular crescent was 60.09% in patients with crescentic GN.80.58%,54.56% and56.18% in type Ⅰ,type Ⅱ and type Ⅲ crescentic GN,and the mean percentage of glomeruli with cellular crescent in patients with type Ⅰ crescentic GN was the highest among the three types,with statistically significant.4.Treatment options for patients with crescentic GN include intravenous hormones,plasma exchange,renal replacement therapy(hemodialysis,peritoneal dialysis),rituximab,and immunosuppressants(cyclophosphamide).Patients with type Ⅰ crescentic GN had the highest percentage of receiving plasma exchange and renal replacement therapy compared to patients with type Ⅱ crescentic GN or type Ⅲ crescentic GN.5.37 crescentic GN patients had a primary outcome during follow-up,patients with type Ⅱ crescentic GN had the lowest rate of primary outcome.20 crescentic GN patients reached the survival endpoint,of which 3(30%)were type Ⅰ crescentic GN,1(5.56%)were type Ⅱ crescentic GN,and 16(59.26%)were type Ⅲ crescentic GN.Patients with type I had a better long-term prognosis than type Ⅲ.30 reached the kidney end point event,of which 7 were(70%)type Ⅰ crescentic GN,7(38.89%)were type Ⅱ crescentic GN,and 16(59.26%)were type Ⅲ crescentic GN(38.89%).Patients with type Ⅱ having the best long-term renal prognosis.The risk factors affecting the occurrence of major outcome events in patients with crescentic GN included pathological type(type Ⅱ vs type Ⅲ: HR = 0.29,CI: 0.12-0.68,P = 0.004)and percentage of cellular crescent(HR = 1.02,CI: 1.01-1.04,P = 0.008).The risk factors for long-term renal prognosis included pathological type(type Ⅱ vs type Ⅲ:HR=0.32,CI: 0.13-0.78,P=0.013)and percentage of cellular crescent(HR=1.03,CI:1.00-1.04,P=0.009).The risk factor for long-term patient prognosis was pathological type(type Ⅱ vs type Ⅲ: HR=0.09,CI: 0.01-0.77,P=0.027).Factors associated with the rate of decline in glomerular filtration rate(GFR)included type of pathology(type Ⅱ vs type Ⅲ: β = 22.63,CI: 1.65-43.61,type Ⅱ vs type Ⅲ: P =0.035)and baseline Scr(β = 0.026,CI: 0.003-0.05,P = 0.028).Conclusion:1.Type Ⅲ crescentic GN is the common pathological type of crescentic GN in this retrospective study.2.The mean age of patients with type Ⅲ crescentic GN is the largest,and the onset of the disease is mostly seen in middle-aged and elderly people.Patients with type I crescentic GN had the highest mean percentage of cellular crescent and more severe glomerular lesions than type Ⅱ crescentic GN and type Ⅲ crescentic GN,while the proportion of patients receiving plasma replacement and renal replacement therapy was higher than that of type Ⅱ crescentic GN and type Ⅲ crescentic GN.3.In this retrospective study,pathological type was an influencing factor for long-term prognosis and renal long-term prognosis in patients with CrGN,and the pathology type with the best long-term renal prognosis was type Ⅱ CrGN,and the long-term prognosis of patients with type Ⅱ CrGN was better than that of type Ⅲ CrGN.in addition,the percentage of cellular crescent was an influencing factor for long-term renal prognosis,and baseline creatinine level was correlated with the rate of decline in e GFR,both of which may be renal Factors influencing long-term prognosis. |
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