Rapidly progressive glomerulonephritis other diagnostic studies
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- Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Renal biopsy
Light microscopy usually shows
- Crescentic glomerulonephritis: fibrinoid tuft necrosis. It can be associated with systemic vasculitis.
- In microscopic polyangitis and Wegener’s granulomatosis: crescentic glomerulonephritis can present without fibrinoid necrosis.
- Focal and segmental mesangial proliferative glomerulonephritis.
- Necrotizing glomerulonephritis, focal proliferative and membranous with foci of fibrinoid necrosis were the next most common category having 1 case each.
- Of the 30 parameters under which every renal biopsy (120) in the present study was scored as detailed in materials and methods; the most common parameters observed in ANCA positive biopsies were- fibrinoid necrosis, glomerular loop neutrophil infiltration, interstitial oedema and arterial hyalinization (all seen in 80% ANCA positive renal biopsies).
- Tubular changes in the form of atrophy and presence of casts and glomerular sclerosis (73.33%) were the next most common changes followed by peri-glomerular infiltrate along with myointimal hyperplasia
- Glomerular basement membrane thickening and arterial hyalinization
- Tubular atrophy and focal interstitial infiltration
- Fibrinoid necrosis of the glomerular tuft was seen in 80% of the glomeruli.
- Neutrophilic infiltration of the glomerular capillary loops.
- 45% of glomeruli had (predominantly cellular) crescents and 23% were globally sclerotic.
- Increased mesangial proliferation
- Interstitial edema: interstitial oedema was seen in 80% of ANCA positive biopsies and interstitial infiltrate was seen either focally or in diffuse fashion.
- Focal tubular epithelial flattening as the most common findings seen in tubules of pauci-immune glomerulonephritis.
- In interstitium; interstitial infiltration by leukocytes is common and is most pronounced adjacent to severely inflamed glomeruli or vessels.
- In both cases mononuclear infiltrate formed the predominant part (86.66%), of the infiltrate of ANCA positive cases followed by neutrophils and eosinophils in 26.66% and 20.00% cases respectively. Interstitial fibrosis was present in 60% of ANCA positive biopsies in this study. Many studies such as the one conducted by Haeur et al., have also noted the presence of interstitial oedema but only in 34% of biopsies along with interstitial infiltrates (predominantly mononuclear) in 92% of biopsies and fibrosis was present in 83% of biopsies.
- interstitial eosinophilic infiltrate
Immunofluorescence microscopy
- Immunofluorescence microscopy shows finding of linear deposition of immunoglobulin G (IgG) along the glomerular capillaries and occasionally the distal tubules.