Research ArticlesThe Clinicopathologic Spectrum of Rapidly Progressive Glomerulonephritis Based on Glomerular Immune Deposition and Antineutrophil Cytoplasmic AntibodyHan, Fei MD*,†,‡; Chen, Liangliang MD*,†,‡; Le, Jingyun MD*,†,‡; Choong, Peijing MD*,†,‡; Xu, Ying MD*,†,‡; Wang, Huiping MD*,†,‡; Chen, Jianghua MD*,†,‡Author Information *Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University †Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province ‡The Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, P.R. China Supported by the medical research funds from Bureau of Health, Zhejiang Province (2011RCB017, 2013KYA072) and the National 973 Project (201CB517603). The authors declare no conflict of interest. Reprints: Jianghua Chen, MD, 79 Qingchun Road, Hangzhou, Zhejiang Province 310003, P.R. China (e-mail: [email protected]). Received June 1, 2014 Accepted July 16, 2014 Applied Immunohistochemistry & Molecular Morphology: November/December 2015 - Volume 23 - Issue 10 - p 704-710 doi: 10.1097/PAI.0000000000000134 Buy Metrics Abstract Rapidly progressive glomerulonephritis presents crescentic glomerulonephritis (CrGN) pathologically. Immune complex (IC)-mediated CrGN is characterized by glomerular IC deposits, whereas pauci-immune CrGN is characterized by presence of antineutrophil cytoplasmic antibody (ANCA) and absence of glomerular IC deposits. CrGN cases presenting both IC deposits and ANCA were common. We retrospectively investigated 91patients with rapidly progressive glomerulonephritis, including 36 patients with idiopathic IC-mediated CrGN and 55 patients with pauci-immune CrGN. On the basis of ANCA and IC deposits, there were 42 patients with ANCA alone (ANCA+IC−), 6 patients with IC deposits alone (ANCA−IC+), 30 patients with both ANCA and IC deposits (ANCA+IC+), and 13 patients with neither ANCA nor IC deposits. The patients with IC-mediated CrGN had more proteinuria, lower estimated glomerular filtration rate (eGFR), higher percentage of cellular crescent formation, and a worse renal outcome compared with those with pauci-immune CrGN. The ANCA+IC+ CrGN patients had lower eGFR level, higher percentage of crescent formation and a tendency of more proteinuria, and worse renal outcome compared with ANCA+IC− CrGN patients, but had no significant differences on the above characteristics compared with ANCA−IC+ CrGN patients. Within a median 7.1 months, 22 patients developed end-stage renal disease. Cox regression revealed the factors including lower eGFR level, more proteinuria, lower platelet level, higher glomerular global sclerosis rate, and glomerular IgG deposits were the independent factors for worse renal outcome. In conclusion, the clinicopathologic spectrum of ANCA+IC+ CrGN was similar with IC-mediated CrGN and glomerular IgG deposition was one of the independent factors for worse renal outcome. Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.