Crescentic Glomerulonephritis in a Sub-Saharan Country: Clinical Presentation, Etiological and Evolutive Profile

Crescentic extra-capillary glomerulonephritis (ECGN) is a diagnostic and therapeutic emergency. In black Africans, little data are available on this lesion. This study aimed at determining the clinical/biological and evolutionary patterns of ECGN and identifying factors of poor prognosis.
This was a retrospective study conducted over a period of 5 years. All patients with extra-capillary proliferation of ≥ 50% in Bowman’s space upon kidney biopsy were involved. The researchers compared 2 groups of patients: group A (patients, who fully recovered from renal function after 3 months of treatment) and group B (patients developing signs of chronic renal insufficiency) in order to identify factors responsible for a poor renal prognosis.
Forty cases of crescentic glomerulonephritis were found in 750 kidney biopsies, i.e. a prevalence of 5.33%. The mean age of the patients was 33.9 ± 16.65 years, with a gender ratio of 0.53. Upon admission, 85% of cases had renal insufficiency, with oligoanuria present in 62.5%. By employing light microscopy, the crescents were found to be cellular in 60%, fibro-cellular in 32.5%, and fibrous in 7.5%. The etiologies were mainly lupus in 32.5% of cases, followed by ANCA-related vasculitis in 27.5% of cases, and infectious causes in 17.5% of cases. Outside of the infectious context, basic treatment relied on immune suppression combining corticosteroids and cytotoxic drugs. The evolution was marked by transition to a chronic state in 72.7% of cases; 18.2% of patients recovered normal renal function. The factors responsible for a poor renal prognosis were oligoanuria (P = 0.0008), high creatinine level upon admission (P = 0.0001), use of hemodialysis (P = 0.0001), and evidence of fibro-cellular and fibrous crescents (P = 0.013).
Crescentic glomerulonephritis was relatively common in the current patients. The etiology was dominated by lupus in the study’s context. This rapidly causes chronic renal failure, hence explaining the interest in early management.