Glomerulonephritis presented as acute severe renal failure [ASRF]

ABSTRACT

To investigate the aetiology, clinical features, histological diagnosis and response to treatment of patients with glomeulonephritis presenting as acute renal failure [ARF] or rapidly progressive glomerulonephritis [RPGN]. Of the 66 patients with ARF, admitted in the Nephrology department of BSMMU, Dhaka in the period January 1998 to June 1999, 19 presented clinically as RPGN. They were evaluated for histological diagnosis and clinical outcome. There were 11 males and 8 females with a mean age of 31 +/- 4.62 years. The mean arterial B.P. was 103 +/- 6.8 mmHg, urinary total protein 2.7 +/- 1.9 gm/24 hours, urinary RBC 12 +/- 3.8 per high power field. Mean blood urea was 118.9 +/- 11.76 mg% and S.creatinine 7.78 +/- 4.3 mg%. Immunohistological findings revealed crescentic GN in 8 [42.11%], glomerulonephritis without crescent 11[57.89%] and granular deposition of the immunoglobulin and complement in 11 [73.33%] cases. Patients were treated with methyiprednlsolone for 3 days followed by oral prednisolone and cyclophosphamide as per schedule protocol along with acute haemodialysis through temporary venous catheter. Nine [47.37%] patients died, 6 [31.57%] improved and 4 [21.10%] developed CRF. The study showed that among the patients with ARF, 28% presented with RPGN. The prognosis was uniformly had, although 1/3rd improved with appropriate and early treatment