Rapidly progressive glomerulonephritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Natural history, complications and prognosis
Natural history
- Patients with RPGN present with initial flu like symptoms and then progress to nephritc syndrome in 2-3 months if not treated in time.
- Symptoms include malaise, arthralgias, fever, anorexia, weight loss, haematuria, edema, hypertension and abdominal pain.
- Patients with respiratory system involvement as in Goodpasture syndrome and Churg strauss, have symtopms of asthma, atopy and haemoptysis as well.
- RPGN can lead to ARF when renal symptoms develop.
- Increase in serum creatinine and fall in GFR are used to measure the severity of the disease.
- 70-80% Patients with RPGN will progress to end stage renal disease if not treated in time.
- Serum creatinine >4.6 mg/dl and GFR less than 50% denote end stage renal disease and requires dialysis.
- Histopathologically, the presence of fibrous crescents indicate irreversible renal damage and poor prognosis.
Complications
- Nephritic syndrome
- Nephrotic syndrome
- Acute kidney injury
- Chronic renal failure
- End stage renal disease
Prognosis
- The prognosis of rapidly progressive glomerulonephritis is poor due to rapid deterioration of kidney function in a few weeks.
- Prognosis depends on :
- Age
- Serum creatinine
- Presence of pulmonary symptoms at the onset of disease
- Race
- Presence of ANCA
- Presence of fibrous cresecnts on histopathology.
- Factors that are indicators of poor prognosis :
- Age >60 years
- Serum creatinine > 7.5 mg/dl.
- Oliguric renal failure
- Pauci immune RPGN
- White race
- 75 % fibrous cresecents in the glomerulus
- 70-80% of patients with RPGN develop end stage renal disease and require dialysis for a long time.