Đặc điểm mô bệnh học của viêm cầu thận liềm ở bệnh nhân suy thận tiến triển nhanh

Rapidly progressive renal failure (RPRF) represents a severe clinical syndrome characterized by a swift decline in kidney function, often leading to end-stage renal disease. Among its diverse etiologies, crescentic glomerulonephritis (CGN), defined by the presence of crescents in over 50% of glomeruli, stands as a critical and frequent cause. Accurate histopathological diagnosis and a thorough understanding of the specific crescentic lesions are paramount for guiding effective treatment and predicting patient outcomes. This study aims to delineate the frequency, underlying etiologies, and characteristic histopathological patterns of crescentic glomerulonephritis in Vietnamese patients presenting with RPRF, contributing crucial insights to clinical practice.

Nephrologists, renal pathologists, internal medicine physicians specializing in kidney diseases, medical researchers in nephrology, and postgraduate medical students.

This cross-sectional, descriptive case series investigated the histopathological characteristics of crescentic glomerulonephritis (CGN) in patients with rapidly progressive renal failure (RPRF) at Gia Dinh People Hospital from January 2015 to December 2020. Analyzing 184 kidney biopsies from RPRF patients, the study identified CGN in 23 cases, accounting for 12.5% of the total. The predominant etiology for CGN was immune complex-mediated glomerulonephritis (91.4%), with lupus nephritis being the most common cause (65.2%), followed by IgA nephropathy (17.4%). A significant finding was the universal presence of fibrinoid necrosis in all underlying etiologies. The study detailed the distribution of crescent types, observing that lupus nephritis presented all three morphological types—cellular crescent, fibrocellular crescent, and fibrous crescent—while IgA nephropathy predominantly featured cellular and fibrocellular crescents. Variations in the combination and prevalence of these crescent types were noted across different etiological groups. These findings underscore the importance of precise histopathological evaluation in differentiating CGN etiologies and understanding disease progression, which has direct implications for patient management and prognosis in RPRF.