#2968 PROGNOSIS OF CRESCENTIC GLOMERULONEPHRITIS IN ADULTS

Abstract Background and Aims Crescentic glomerulonephritis (C-GN) is characterized by severe glomerular inflammation and injury that leads to crescent formation, rapid loss of kidney function and severe prognosis in absence of prompt immunosuppressive therapy. Depending on the histological findings, there are three main types of C-GN: anti-glomerular basement membrane antibody GN (anti-GBM GN), immune complex GN, and pauci-immune GN. This study aims to assess whether the kidney and vital outcome are different among the three histologic types of crescentic GN. Method This unicentric, retrospective study included seventy-six subjects [50% males, 55 (95%CI 52 to 60) years; eGFR 9.6 (95%CI 7.8-13.7) mL/min and proteinuria 1.9 (95%CI 1.5 to 2.6) g/g] that had undergone a kidney biopsy between 1st January 2008 and 31st December 2017 and had a histologic diagnosis of crescentic glomerulonephritis (crescent formation in more than 50% of the glomeruli). The subjects were followed for a mean of 47.6 (95%CI 33.5 to 61.6) months. Primary endpoints were the need of renal replacement therapy initiation (RRT) and all cause death. Kaplan-Meier method was used to evaluate kidney and patients’ survival and variables related to kidney and vital outcome were evaluated by multivariate Cox proportional hazard modelling. Patients were stratified in three groups according to the type of C-GN: pauci-immune GN (n=58 pts.), anti-GBM GN (n=9 pts.) and immune-complex GN (n=9 pts.). Results No demographic differences were found among the three groups. Except for a higher frequency of solid neoplasia in immune-complex GN group (2.7% vs 1.3% in pauci-immune GN vs. 0% in anti-GBM GN; P = .001), no other differences regarding the clinical or laboratory data were identified. Immunosuppressive treatment was very frequent, in more than 80% of subjects, regardless of the group, corticotherapy and cyclophosphamide being the most common immunosuppressive agents. During the follow-up period, 54% of subjects needed RRT and 19.2% died. The frequency of RRT initiation or death was not different among the three groups (P = .9 and P = .4). The univariate time-dependent analysis showed similar survival times among the analysed groups (log rank =0.9) (Figure 1). In the multivariate analysis, the only independent predictor of RRT was lower baseline eGFR (OR 0.49 (95%CI 0.31 to 0.78), P = .03). Time to death did not differ among groups (log rank P = .4) (Figure 2). The only independent predictor of death was higher Charlson comorbidity score (OR 56.8 (95%CI 6.3 to 512), p<0.001) in the Cox analysis. Conclusion In this cohort of subjects with crescentic glomerulonephritis, although limited by the low number of subjects, the kidney and vital prognosis seem to be similar indifferent of the histologic type of crescentic glomerulonephritis.