Rapidly Progressive Glomerulonephritis Follow-up

Updated: Mar 31, 2015
  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Follow-up

Further Outpatient Care

Close follow-up care is extremely important in any patient with active vasculitis. The therapies for ANCA-associated vasculitides are not proven in large, randomized, controlled trials but are the standard of care according to consensus. The same can be said for the definitions of relapse, response, and treatment failure.

The following criteria were established by Nachman et al before they performed a randomized control trial comparing immunosuppression regimens in patients diagnosed with microscopic polyangiitis or isolated pauci-immune rapidly progressive glomerulonephritis only (patients with granulomatosis with polyangiitis were excluded). [4]

Remission criteria are as follows:

  • Stabilization or improvement of renal function (as measured by serum creatinine value), resolution of hematuria, and resolution of extrarenal manifestations of systemic vasculitis
  • Persistence of proteinuria not considered indicative of persistent disease activity

Remission by therapy is defined as achievement of remission while still receiving immunosuppressive medication or corticosteroids (prednisone dose or equivalent of >7.5 mg/d)

Treatment resistance is defined as follows:

  • Progressive decline in renal function with the persistence of an active urine sediment
  • Persistence or new appearance of any extrarenal manifestation of vasculitis despite immunosuppressive therapy

Relapse criteria include at least one of the following:

  • Rapid rise in serum creatinine concentration, accompanied by an active urine sediment
  • Renal biopsy findings demonstrating active necrosis or crescent formation
  • Hemoptysis, pulmonary hemorrhage, or new or expanding nodules without evidence for infection
  • Active vasculitis of the respiratory or GI tracts as demonstrated by findings from endoscopic biopsy
  • Iritis or uveitis
  • New mononeuritis multiplex
  • Necrotizing vasculitis identified based on findings from biopsy specimen of any tissue
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Prognosis

When treatment is initiated early, most patients with rapidly progressive crescentic glomerulonephritis achieve a complete or partial remission. Usually, the higher the serum creatinine at presentation the worse the outcome, but some patients requiring dialysis may recover good renal function. [7]

In a retrospective analysis of patients with microscopic polyangiitis and mainly renal involvement, Kawai et al found that a baseline serum creatinine value of greater than 4.6 mg/dL predicted progression to end-stage renal failure. However, serum creatinine levels did not differ significantly between survivors and non-survivors. [8]

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Patient Education

For patient education information, see the Infections Center and Digestive Disorders Center, as well as Hepatitis B, Hepatitis C, and Cirrhosis.

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