The Immunopathological Spectrum of Crescentic Glomerulonephritis: A Survey of 106 Patients in a Single Chinese Center

BACKGROUND: Crescentic glomerulonephritis (CrGN) is a severe form of glomerular injury. We retrospectively analyzed data from Chinese patients with CrGN in our center to characterize the immunopathological spectrum of CrGN. METHODS: A total of 106 consecutive patients with biopsy-proven CrGN were recruited. CrGN was classified into 3 types according to findings on immunofluorescence microscopy; type I was defined as a linear deposition of immunoglobulins along the glomerular basement membrane (GBM), type II as a glomerular deposition of immune-complex and type III as a pauci-immune deposition. RESULTS: A total of 17/106 (16.0%) patients were classified as type I, 43/106 (40.6%) as type II and 46/106 (43.4%) as type III. Serum antineutrophil cytoplasmic antibodies (ANCA) could be detected in 1/17 (5.9%) patient with type I, 11/43 (25.6%) patients with type II and 29/46 (63.0%) patients with type III CrGN (p < 0.001). Serum anti-GBM antibodies could be detected in 14/17 (82.4%) patients with type I, 2/43 (4.7%) patients with type II and 3/46 (6.5%) patients with type III. In type II CrGN, ANCA-positive patients were older (p < 0.001), had more multi-system involvement (p < 0.001) and more fibrinoid necrosis in renal histopathology than ANCA-negative patients (p = 0.003). CONCLUSIONS: Pauci-immune CrGN might be the most common type of CrGN in Northern China. There was much heterogeneity within each type of CrGN.