Trastornos glomerulares en la práctica médica / Glomerulopathies in the medical practice

RESUMEN Las glomerulopatías agrupan varias nefropatías con lesiones fundamentalmente del corpúsculo renal y que se expresan principalmente por proteinuria, hematuria, edemas e hipertensión arterial. La presentación clínica varía en dependencia del tipo de enfermedad de que se trate. Constituye la causa más frecuente de enfermedad renal crónica en adultos jóvenes, por lo que su estudio resulta imprescindible sobre todo para el nivel primario de salud. El propósito fue actualizar consideraciones pertinentes sobre la conducta diagnóstica y terapéutica integral ante una glomerulopatía y valorar emisión de recomendaciones al respecto. Se realizó una búsqueda, análisis y síntesis de información a través de Bases de datos ScieLO Cuba, ScieLO regional, Pubmed, Cumed, Clinical Key en el período 2012-2017 con las palabras clave: síndrome nefrótico, glomerulonefritis, diagnóstico, terapéutica, atención integral. El abordaje en las glomerulopatías es integral, multidisciplinario e individualizado. En Cuba constituyen la cuarta causa de enfermedad renal crónica y predomina el síndrome nefrítico agudo postinfeccioso. El método clínico juega en ello un papel trascendental a la hora de reconocer y registrar sus aspectos clínicos, su etiología, su fisiopatología, y los exámenes complementarios que confirman su presencia o sus complicaciones, así como un tratamiento oportuno que garanticen el perfeccionamiento asistencial. El arma más poderosa ante el reto de los trastornos glomerulares es la visión integradora y con enfoque individual y social protagonizado por el médico ante este grupo de nefropatías en adultos.

ABSTRACT Glomerulopathies encompass a group of several renal disorders with lesions, mainly in the renal corpuscle, expressed in proteinuria, hematuria, edemas and arterial hypertension. Their clinical manifestations change in dependence of the kind of disease. They are the most frequent cause of chronic renal disease in young adults; therefore their study is very important above all in the health care primary level. The aim was updating pertinent considerations on the diagnostic behavior and comprehensive therapy in the case of glomerulopathy, and evaluating the emission of recommendations regarding to them. A search, analysis and synthesis of information was carried out in the databases ScieLO Cuba, ScieLO regional, Pubmed, Cumed, and Clinical Key in the period 2012-2017, using the key words nephrotic syndrome, glomerulonephritis, diagnosis, therapeutics, comprehensive care. The approach to glomerulopathies is comprehensive, multidisciplinary and individualized. They are the fourth cause of chronic renal disease; the acute post-infectious nephritic syndrome predominates. The clinical method plays a transcendental role at the moment of recognizing and registering their clinical characteristics, etiology and physiopathology, while complementary tests confirm their presence or complications, and therefore an opportune treatment guarantying the healthcare improvement. The most powerful weapon against the challenge of the glomerular disorders is the integrated vision with an individual and social approach led by the physician in the case of these nephropathies in adults.

Síndrome pulmón-riñón: serie de 12 casos / Pulmonary renal syndrome: series of 12 cases

El síndrome pulmón-riñón es una entidad infrecuente, que comprende un gran espectro de patologías, como las vasculitis asociadas a ANCA y la enfermedad por anticuerpos antimembrana basal glomerular entre otras. Se describen en esta serie 12 casos donde las entidades más prevalentes fueron las antes mencionadas, observándose además un caso de lupus y uno de granulomatosis con poliangeítis, que se encuentran dentro de las causas menos frecuentes. La forma de presentación clínica inicial fue simultánea renal y pulmonar en 5/12 pacientes y renal en 7/12 de los mismos. El diagnóstico temprano de dichas patologías basándose en criterios clínicos, radiológicos, de laboratorio e histológicos, permite instaurar terapéuticas tempranas como la inmunosupresión y plasmaféresis, pudiendo prevenir complicaciones tales como las infecciones y la insuficiencia renal crónica terminal, siendo las primeras la principal causa de muerte (AU)

Pulmonary-renal syndrome is an infrequent condition. It includes a wide variety of conditions such as ANCA (antineutro-phil cytoplasmic autoantibody) associated with systemic vasculitis and anti-GBM (anti-glomerular basement membrane) disease among others. In this series we describe twelve cases, in which the most prevalent diseases were the above mentioned as well as one case of lupus and one of granulomatosis with polyangiitis (these being less frequent causes). The clinical presentation was both renal and pulmonary simultaneously in five of twelve patients and renal in seven of twelve patients. Early diagnosis of this condition on the basis of clinical, radiological, histological and analytic criteria allows early treatments such as immunosuppression and plasma exchange, thus avoiding complications such as infections (the main cause of death) and terminal chronic renal failure (AU)

Glomerulonefritis aguda con requerimiento de diálisis asociada a influenza A H1N1pdm09: comunicación de dos casos / Acute glomerulonephritis with hemodialysis requirement secondary to influenza A H1N1pdm09 infection: report of two cases

Acute renal failure (ARF) requiring hemodialysis is not common among patients affected by influenza. We report two unvaccinated adult patients with smoking habit, which were admitted with severe influenza A H1N1pdm09 that evolved with shock and required mechanical ventilation. Both patients developed progressive renal failure with oliguria/anuria, associated with urinary of inflammatory sediment with proteinuria, microhematuria and in one case also with hypocomplementemia, suggesting acute glomerulonephritis. Renal replacement therapy (RRT) was required in both cases. In one patient, who died of late complications, sequencing of the HA1 segment revealed the previously described D222N mutation associated to severe cases. ARF with RRT appears to be an uncommon complication of patients hospitalized for influenza A H1N1pdm09 and may be secondary to acute glomerulonephritis.

La insuficiencia renal aguda (IRA) que requiere hemodiálisis no es una complicación común entre los pacientes afectados por influenza. Se comunican los casos clínicos de dos pacientes adultos fumadores no vacunados, que se internaron por influenza A H1N1pdm09 grave por shock y necesidad de ventilación mecánica. Ambos desarrollaron una falla renal progresiva con oliguria/anuria, asociada a un sedimento de orina inflamatorio con proteinuria, microhematuria y en un caso además con hipocomplementemia, sugiriendo una glomerulonefritis aguda. Se requirió terapia de reemplazo renal (TRR) en ambos casos. En uno de los pacientes, que falleció por complicaciones tardías, la secuenciación del segmento HA1 reveló la mutación D222N previamente descrita en casos graves. La IRA con TRR parece ser una complicación infrecuente de los pacientes ingresados por influenza A H1N1pdm09 y puede ser secundaria a una glomerulonefritis aguda.

Patogênese e tratamento da glomerulonefrite - uma atualização / Pathogenesis and treatment of glomerulonephritis-an update

Resumo A presente revisão traz os conceitos mais atuais acerca dos fatores de risco genéticos, eventos etiológicos, respostas nefritogênicas e tratamento dos principais tipos de glomerulonefrite (GN) imunomediada. Tais patologias incluem GN pós-infecciosa, nefropatia por IgA, doença por anticorpo antimembrana basal glomerular (anti-MBG), vasculite associada a ANCA (VAA) e nefrite lúpica. Apesar da(s) etiologia(s) da maioria dos casos de GN permanecer indefinida, acredita-se que seu início se deva, em grande parte, a insultos ambientais, particularmente na forma de processos infecciosos que deflagram respostas de hospedeiro em indivíduos geneticamente suscetíveis, levando assim a quadros de GN. A concepção mecanicista em torno dessas patologias evoluiu a partir da visão mais antiga de que a maioria seria consequência do aprisionamento glomerular de complexos imunes pré-formados para a percepção atual de que as mesmas, em sua maioria, são doenças autoimunes por natureza mediadas por anticorpos e linfócitos T reativos a auto-antígenos. O tratamento da GN não tem acompanhado os progressos na compreensão de sua patogênese. Os papéis recentemente atribuídos a mediadores mais antigos como complemento e proteínas reguladoras do complemento lançam luz sobre novos alvos terapêuticos.

Abstract This review updates current concepts of the genetic risk factors, etiologic events, nephtitogenic responses and treatment of the major immunologically mediated types of glomerulonephritis (GN). These include post-infectious GN, IgA nephropathy, anti-glomerular basement membrane (GBM) antibody disease, ANCA-associated vasculitis (AAV) and lupus nephritis. Although the etiology(s) of most GNs remain undefined, many are now believed to be initiated by environmental insults, particularly infectious processes, that trigger host responses in genetically susceptible individuals which lead to GN. Mechanistic concepts of these diseases have evolved from earlier views that most were consequent to glomerular trapping of preformed immune complexes to the current view that most of these diseases are auto-immune in nature mediated by both antibodies and T cells reactive with self-antigens. Therapy of GN has lagged behind advances in understanding pathogenesis. Newly appreciated roles for older mediators like complement and complement regulatory proteins offer new therapeutic targets.

Glomerulonefritis lúpica y otras glomerulopatías autoinmunes / Lupus glomerulonephritis and other autoimmune glomerulonephritis

La glomerulonefritis es un término empleado para expresar la proliferación e inflamación endocapilar del glomérulo renal, que clínicamente puede manifestarse de numerosas formas e incluso permanecer asintomática. En su etiología se encuentran múltiples mecanismos, como la participación de microorganismos y parásitos, aunque es destacable el mecanismo autoinmune en el que se identifican varios componentes del sistema inmune, entre ellos el sistema del complemento. Un ejemplo de este último mecanismo es la glomerulonefritis secundaria al Lupus Eritematoso Sistémico (LES), que ha sido objeto de investigación en los últimos años, y en la que se han hecho importantes avances en cuanto al descubrimiento de nuevas moléculas implicadas en el proceso etiopatogénico. Esto ha conseguido abrir una puerta a nuevas terapias que reduzcan la mortalidad y mejoren la calidad de vida. Se ha revisado la fisiopatología, clínica, diagnóstico, pronóstico y tratamientos, incluyendo los emergentes, en cuanto a glomerulonefritis haciendo hincapié en la glomerulonefritis lúpica y otras glomerulonefritis de mecanismo igualmente autoinmune.

Patterns of Glomerulonephritis in Uttarakhand State 13 Years Single Centre Experience at Teaching Institute.

Aims : Glomerular disease is considered to be a common cause of chronic kidney disease and its prevalence and histological pattern differ according to geographical area, race, age in different regions of the world. The present study was therefore conducted to study the pattern of different histological types of glomerulonephritis in this area of Uttarakhand region of India over an extended period of 13 years. Material and Methods : Retrospective study was conducted in the tertiary care centre of Uttarakhand state which included cases of different types of glomerulonephritis diagnosed on histopathology over a period of 13 years. Age, sex, clinical presentation, relevant investigations and the histopathological type of glomerulonephritis were noted for every case. Results : Histopathological examination due to various non-neoplastic renal diseases was done in total 218 cases and out of these glomerular diseases was diagnosed in 178 cases. Proteinurea and edema was the most common presentation. Primary glomerulonephritis was observed in 88.5% cases and secondary in 9.9%. Mesangioprolifrative glomerulonephritis was the most common primary glomerulonephritis and nephropathy due to amyloidosis was the most common type of secondary glomerulonephritis. Conclusion : The study concludes that primary glomerulonephritis is the most common renal disease with mesangioproliferative glomerulonephritis as the most common primary glomerulonephritis and amyloidosis nephropathy as the most common secondary glomerulonephritis which differs from other regions of world. The study may be useful to pathologists, nephrologists and health care providers to formulate a basic platform for effective diagnostic, therapeutic and research base for glomerular diseases so as to prevent its complications.

Glomerulonefritis rápidamente progresiva en ancianos / Rapidly progressive crescentic glomerulonephritis in the elderly

La glomerulonefritis rápidamente progresiva (GNRP) es un síndrome clínico que se caracteriza por la presencia de signos urinarios de enfermedad glomerular e insuficiencia renal de desarrollo en un lapso de días a pocos meses. La inmunofluorescencia permite clasificar a las GNRP en cuatro tipos según se identifiquen o no depósitos inmunes y, si están presentes, de acuerdo con su naturaleza. En la última década se ha demostrado un aumento constante en el promedio de edad de los pacientes con GNRP. Este fenómeno podría reflejar tanto una mayor incidencia de la enfermedad, como un incremento en la tasa de diagnóstico. Se presentan 3 casos de GNRP en adultos mayores de 65 años, diagnosticados en un periodo de 3 meses en nuestra institución.

Rapidly progressive glomerulonephritis (RPGN) is a syndrome characterized by glomerular lesions giving rise to acute renal injury that develops within a brief period of time, usually days or a few months. It is classified according to the underlying mechanism of injury and the immunofluorescence findings into four main disorders. In the last decade, nephrologists have witnessed a steady rise in the mean age of the patients diagnosed with RPGN. This observation may reflect an increase in the incidence of this entity and also a more timely diagnosis. We present 3 cases of RPGN in elderly patients, diagnosed within a 3-month period at our institution which illustrates the spectrum of these conditions.

Pulmonary renal syndrome in a case of wegener´s granulomatosis.

We report a case of a 42-year-old patient who presented with Wegener’s granulomatosis complicated by pulmonary renal syndrome, i.e., diffuse alveolar haemorrhage and rapidly progressive crescentic glomerulonephritis. The patient was treated with plasmapheresis and immunosuppressive drugs — intravenous cyclophosphamide and methyl prednisolone. The clinical, haematological and biochemical parameters improved substantially and remission is achieved.

Chronic renal failure in Jamaican children: an update (2001-2006) / Insuficiencia renal crónica en niños jamaicanos: actualización (2001-2006)

OBJECTIVE: This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006. METHODS: The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide. RESULTS: Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis. CONCLUSION: The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.

OBJETIVO: Este estudio evaluó la incidencia, epidemiología, etiología y resultado de la insuficiencia renal crónica (IRC) en niños jamaicanos menores de 12 años entre 2001 y 2006. MÉTODOS: Los datos requeridos sobre los niños que satisfacían los criterios de inclusión, fueron obtenidos a partir de sus historias clínicas en el Hospital Universitario de West Indies y en el Hospital Pediátrico Bustamante, así como a partir de médicos en hospitales que prestan atención a niños en todo el país. RESULTADOS: Dieciocho nuevos niños (72.2% varones) presentaron IRC. La incidencia acumulada anual fue de 4.61 por millón de población infantil menor de 12 años de edad o 1.14 por millón de población total. La enfermedad urológica congénita (44.5%) fue la causa más común de IRC, seguida por la glomerulonefritis (33.3%). La mitad de los casos de glomerulonefritis fueron secundarios a la nefropatía asociada al VIH. Aunque todos los niños con válvulas uretrales posteriores fueron diagnosticados antes de los 6 meses de edad y puestos bajos tratamiento, la insuficiencia renal presente al nacer resultó irreversible. La edad promedio al momento del diagnóstico de la IRC fue 6.72 años. Diez niños (55.6%) se hallaban ya con IRC desde que se les presentara inicialmente la enfermedad renal. De estos, los cinco con enfermedad no urológica se hallaban ya en la fase terminal de la enfermedad renal (ERT). La mortalidad fue de 44.4%. Cinco niños murieron en la ERT sin el beneficio de la diálisis. CONCLUSIÓN: La incidencia de la IRC ha aumentado desde el estudio local de 1985-2000, principalmente debido a patologías urológicas que progresan a pesar del diagnóstico precoz y el tratamiento. La enfermedad renal no urológica se está presentando demasiado tarde para una intervención terapéutica. Se requiere mayor conciencia pública de los síntomas de la enfermedad renal. El acceso de los niños a la diálisis es imprescindible. Hace falta una diálisis infantil y un programa de transplante.

Glomerulonefrite aguda pós-estreptocócica com proteinúria nefrótica: relato de caso / Nephrotic proteinuria in post-streptococcal acute glomerulonephritis: case report

Refere-se a um caso atendido com quadro clínico e laborato­rial sugestivos de glomerulonefrite aguda pós-estreptocócica (GNPE) apresentando proteinúria em níveis nefróticos. Como em apenas 5% dos casos de GNPE há proteinúria em níveis nefróticos, foi necessário excluir outras doenças renais através da realização de biópsia renal com estudo por microscopia óptica, eletrônica e imunofluorescência, que confirmaram a suspeita clínica de GNPE

Acute glomerulonephritis in southern Iran

Acute post streptococcal glomerulonephritis [APSGN] is the most common type of in-patient glomerulonephritis [GN] in childhood. It has not been studied well in this region yet. Here, we report our experience with APSGN in a tertiary referral center during a five-year period. Hospital records of all 137 children who had been admitted to Nemazee hospital, between 2001 and 2006, with diagnosis of acute glomerulonephritis [AGN] were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 137 children diagnosed as AGN, 122 [89%] had APSGN. Other 15 [11%] children had membranoproliferative glomerulonephritis [n=4], mesangioproliferative glomerulonephritis [n=4], IgA nephropathy [n=2], lupus nephritis [n=2], rapidly progressive glomerulonephritis [n=2], and focal segmental glomerulosclerosis [n=1]. Mean [SD] age in children with APSGN was 8.5 [3.5] [range, 3.5-13] years, 117 [96%] children developed APSGN following a sore throat and 5 [4%] following an impetigo, with 95 [78%] during the cold seasons of the year. Periorbital edema was found in 97.5%, hypertension 75%, gross hematuria 72%, oliguria 37%, generalized edema 19%, azotemia [BUN > 20] 80%, and nephrotic-range proteinuria 24.5%. A high anti streptolysin-O [ASO] titer and a low C3 level was detected in 84% and 86%, respectively. There was dilutional anemia in 51.5%, hyponatremia in 27%, and hyperkalemia 14%. With regard to medications, 19 patients received only furosemide, 73 cases furosemide and nifidipine, and 10 patients furosemide, nifidipine, and another antihypertensive medication. Hypertensive encephalopathy occurred in 3 cases, but no mortality was reported during the study period. APSGN is the most common type of glomerulonephritis in this region. It follows sore throat in the majority of cases. It usually has an uneventful course

Glomerulonefritis: revisión del tema / Glomerulonephritis

Las glomerulonefritis (GN) son enfermedades caracterizadas por inflamación glomerular y proliferación celular, asociada a hematuria. Los mecanismos inmunes humorales y los mediados por células, juegan un papel importante en la patogenia de la inflamación glomerular. La enfermedad glomerular tiende a producir síndromes de disfunción renal específica. Sin embargo, diferentes enfermedades glomerulares pueden producir síndromes semejantes. En este trabajo se revisa la fisiopatología, la historia natural y el tratamiento de la hematuria asintomática, la glomerulonefritis aguda y la glomerulonefritis rápidamente progresiva.

Tratamento da doença glomerular com micofenolato mofetil / Treatment of glomerular disease with mycophenolate mofetil

Introdução: As glomerulonefrites (Gns) constituem a principal causa de doença renal crônica no Brasil. O tratamento das Gns inclui corticosteróide associado ou não a outras drogas imunossupressoras. Nos últimos anos, o micofenolato mofetil (MMF), uma droga com eficácia comprovada no transplante de órgãos sólidos, tem sido usada com sucesso no tratamento de várias Gns. O objetivo deste estudo foi relatar oito casos de diferentes Gns tratadas com MMF. Métodos: Retrospectivamente, foram avaliados oito pacientes tratados com MMF, os quais apresentaram ausência de resposta e/ou toxicidade/intolerância a outras drogas imunossupressoras. Quatro pacientes tinham Gn membranosa, 1 paciente tinha glomeruloesclerose segmentar e focal, 1 paciente tinha nefropatia IgA e 2 pacientes tinham nefrite lúpica. O MMF foi dado, inicialmente a todos os pacientes, na dose de 1g duas vezes ao dia, por 3 a 6 meses; posteriormente, a dosefoi reduzida para 500 a 750mg, duas vezes ao dia, como dose de manutenção. A resposta ao MMF foi avaliada pela proteinúria (PN) e a filtração glomerular (FG), estimada pela fórmula do MDRD, usando a creatinina sérica. Resultados: Após o tratamento por 13 (3-36) meses, constatamos que houve redução da PN de 71,41 (de 7,98 para 2,28g/dia) e a preservação da função renal, antes e após o MMF. O MMF provocou total remissão em 3 pacientes e parcial remissão em outros 3. Um paciente não respondeu ao tratamento. Em 2 pacientes, o MMF foi interrompido, porque apresentaram infecção pulmonar e diarréia. Conclusão: O tratamento com o MMF parece ser benéfico nos pacientes com Gns. Novos ensaios controlados seriam necessários para tornar o MMF mais uma opção no tratamento das Gns.

Síndrome nefrítico (Proceso de enfermeria) / Nephritic syndrome (Infirmary Process)

Presenta estudio de procesos de enfermería con el fin de brindar atención integral a la niñez para evitar complicaciones del sindrome nefritico por medios de los planes de cuidados de enfermería que solucionen las necesidades del paciente, familia y comunidad. Durante este estudio se mostro que tanto la teoría como la práctica tienen mucha relación ya que los pacientes presentaban los mismo signos y síntomas que nos ofrecen las bibliografía consultadas. La conclusión del estudio fue lograr sensiblizar al paciente y a su familia con las acciones de enfermería brindadas en visitas domiciliares realizadas. Ademas enriquecer los conocimientos sobre el diagnóstico de síndrome nefrítico y poder diferenciar cuales son las principales causas que pueden ocasionar un síndrome nefrítico, lo cual es una experiencia para los estudiantes de enfermería, teniendo como resultado la recuperación de salud y disminuyendo las diferentes complicaciones del paciente.

Comportamiento clínico y abordaje terapeutico en pacientes de servicio de nefrología con glomerulonefritis rapidamente progresiva menores de 15 años, Hospital Manuel de Jesus Rivera enero 1,999 a diciembre 2,004 / Clinical behavior and therapeutic boarding in patient of nefrology service with quickly progressive glomerulonefritis smaller than 15 years, Hospital Manuel of Jesus Rivera January 1,999 to december 2,004

El presente estudio fue realizado en el servicio de nefrologia del Hospital Manuel de Jesus Rivera, en el período comprendido enero 1999 a diciembre 2004. El objetivo fue conocer el comportamiento clínico y abordaje terapéutico de los pacientes con Glomérulo nefritis rápidamente progresiva, ingresados al servicio de nefrología de ese hospital e instar a los pediatras generales a realizar diagnóstico temprano de esta patología para contribuir a la reducción de la morbi mortalidad por esta causa. La muestra fue de 15 pacientes, la mayoría referidos, predominando en el sexo masculino, los escolares y adolescentes, procedentes de zonas rurales y con estado nutricional eutrófico. La totalidad de los pacientes, presentó un foco infeccioso previo a su ingreso de ellos los más frecuentes fue de localización faríngea y a nivel de la piel...

Lipoxins and lipoxin analogues as potential novel therapeutics in acute renal failure and glomerulonephritis

Lipoxins [LX] are lipoxygenase-derived lipid mediators with both anti-inflammatory and pro-resolution properties in model systems in vitro and in vivo. The bioactivity profile of LX in vitro suggests that they have therapeutic potential in acute renal failure and glomerulonephritis; predictions that have been borne out to date in experimental models of renal disease

Glomerulonephritis presented as acute severe renal failure [ASRF]

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