Phenotype Analysis Of Rapid Progressive Glomerulonephritis Based On Anti-neutrophil Cytoplasmic Antibody And Glomerular Immune Complex Deposition

Objective:To analyze the clinical, pathological and prognostic features of the patients with rapidly progressive glomerulonephritis (RPGN), according to the classification based on serum anti-neutrophil cytoplasmic antibodies (ANCA) and glomerular immune complex (IC) deposition.Methods:This study retrospectively analyzed patients admitted to the First Affiliated Hospital of medical college of Zhejiang University who manifested as RPGN and were followed at least1.5months, and excluded the patients with the diagnosis of anti-glomerular basement membrane antibody nephritis, lupus nephritis, Henoch-Schonlein purpura nephritis, hepatitis B virus-associated nephritis, IgA nephropathy and other known causes. The patients were divided into groups according to the positivity of ANCA and/or glomerular IC deposition. Results:1. Ninety-one patients were included, of which72were with ANCA positive and36were with IC positive (IC+group). The patients in IC+group had significantly higher level of urine protein (3.33±2.16g/24h vs2.40±1.41g/24h, P=0.015) and lower level of eGFR (16.7±14.8ml/min/1.73m2vs25.9±19.4ml/min/1.73m2, P=0.017) than IC-group. There were13patients (36.11%) with end stage renal disease (ESRD) in IC+group while9(16.36%) ESRD patients in IC-group (P=0.045).2. There were30patients with both ANCA and IC positive (ANCA+IC+group),42patients with only ANCA positive (ANCA+IC-group),6patients with only IC positive (ANCA-IC+group) and13patients with neither ANCA nor IC positive (ANCA-IC-group). The urine protein of ANCA-IC+group was4.07±3.16g/24h, which was significantly higher than that in ANCA+IC-group (P=0.029).3. The independent risk factors of ESRD were lower eGFR level, higher urine protein, lower blood platelet level, higher proportion of sclerotic glomerulus and positive glomerular IgG deposition.Conclusion:RPGN with glomerular IC deposition had more urine protein, worse renal function, higher proportion of crescents and worse prognosis. At the onset of the diseases, lower blood platelet, more urine protein, worse eGFR level, higher proportion of sclerotic glomerulus and glomerular IgG depositon were the independent risk factors of ESRD.