Clinicopathological presentation of treatment naivecrescentic v/s non-crescentic lupus nephritis patients

AUTHORS : Doley PK, Alam Shahzad, Sharma Manjuri, Mahanta PJ, Awasthi Shahtakshi, Jain Priyanka
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Introduction:Renal biopsies play an important role in thediagnosis, management and prognosis of patients with lupusnephritis (LN).This paucity of knowledge in this particulararea prompted us to undertake this retrospective analysis ofclinicopathological presentation of biopsy-proven LN.Materials and methods:Biopsy proven (n=120) treatmentnaive LN class IV patients from March 2007 to August2018 were included. Out of these, 85 were class IV non-crescentic and 35 were class IV crescentic lupus nephritispatients. Clinical and histopathological data were studiedretrospectively. Results:Patients with crescentic LN presentedwith significantly more severe disease (anemia, renal failure,higher serum creatinine level and hypertension andhematuria) as compared to the non-crescentic group (p <0.05). Mean scores of activity index and chronicity index increscentic LN patients were significantly higher (p < 0.001and 0.014 respectively), and not crescent but near aboutall parameters (except glomerular sclerosis, p = 0.61 andsubendothelial immune deposition, p = 0.52) of these scoreswere significantly higher in the crescentic group. The averageintensity of IgG, IgA, IgM, and C3 was lower and averageintensity of C1q was higher in the crescentic group. Butonly the difference in IgA reached statistical significance.Conclusion:In our study, crescentic LN patients had lowerhemoglobin levels, with more hematuria and hypertensivepatients and also had higher Activity Index and ChronicityIndex compared to non-crescentic LN. Not only crescentbut, near about all parameters of these scores weresignificantly higher in crescentic group. The average intensityof IgA was significantly higher in non- crescentic groupin IF study.

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