A 5-year retrospective study to determine the spectrum of crescentic glomerulonephritis in three tertiary hospitals in Gauteng Province, South Africa
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i10.3476Keywords:
Rapidly progressive glomerulonephritis, CrescenticAbstract
Background. Rapidly progressive glomerulonephritis is a clinical syndrome that results in rapid decline in kidney function over a period of weeks to months. Its histological hallmark is extensive crescent formation.
Objective. To determine the causes of crescentic glomerulonephritis (CGN) in the South African (SA) setting.
Methods. The number of kidney biopsies performed at three tertiary hospitals during the 5-year study period was determined. Demographic data and serological test results were recorded. The underlying disease process of each of the CGN cases was defined under the three immunopathological categories: anti-glomerular basement membrane disease; immune complex-mediated; and pauci-immune vasculitis.
Results. There were a total of 980 native kidney biopsies performed at the three tertiary hospitals, namely, Chris Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic Hospital and Helen Joseph Hospital, in Gauteng Province, SA, between 1 January 2015 and 31 December 2019. There were 43 crescentic glomerulo nephritidies (4.4%). The patients’ ages ranged from 19 to 65 years, and 30 patients were female. The study comprised a majority of black patients (83.7%). Most CGN cases (39/43; 90.7%) were immune complex-mediated, and the remainder were anti-neutrophil cytoplasmic antibody mediated. The underlying cause of the 39 immune complex-mediated crescentic glomerulo nephritides was lupus nephritis in 32 (82%) cases, post-infectious glomerulonephritis (PIGN) in 2(5.1%), IgA nephropathy in 1 (2.6%) and 4 (10.2%) with an undetermined underlying cause.
Conclusions. This study revealed the predominant cause of CGN to be lupus nephritis in 82.1% of patients, followed by PIGN in 5.1%. The prevalence of CGN was 4.4%. This study emphasises the variation in aetiologies of CGN in sub-Saharan Africa.
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