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Suggest treatment for crescentic glomerulonephritis

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Posted on Tue, 26 May 2015
Question: Hello sir,
My name is XXXX,My father was undergoing a treatment for the kidney disease crescentic glomerulonephritis and we would like to check with you about the treatment approach we are following is the right approach or not ,and we would need your valuable suggestions and expertise on the treatment approach .
If needed we can meet you in person.

Below is my Nephrologist explaining the current condition and tretment:

mr XXXXXXX XXXXXXX was admitted with acute kidney injury class 3 about 6 to 8 weeks back
at the time he had severe sepsis with bilateral pneumonia and dialysis dependent acute kidney injury class 3. is initial serum creatinine wasvery high and urine output was nil
he has been on thrice per week dialysis since past 6 to 8 weeks
he was advised renal biopsy after the first two weeks in view of and resolving acute kidney injury. by then his sepsis had settled and urine output started increasing. however he deferred his decision regarding kidney biopsy the hope that acute kidney injury would resolve gradually as the urine output was increasing. however is serum creatinine remained high about 7 to 8 milligrams per deciliter after6 weeks also.
kidney biopsy shows crescentic glomerulonephritis. more than 50 % of kidney is already damaged permanently
is chances of becoming dialysis independent are less
in view of his elderly age and diabetes and possibility of severe sepsis again heavy immunosuppression cannot be given. hence he was given modified methylprednisolone pulse therapy and is now on tapering dose of steroid
doctor
Answered by Dr. Rakesh Madhyastha (47 minutes later)
Brief Answer:
Correct decision has been taken

Detailed Answer:
Hello

Thanks for the query

Thank you for giving me a comprehensive history and also attaching the reports.
Here are my interpretations

1. They have taken correct clinical decisions based on clinical situation and also lab values
2. Ideally he should have received cyclophosphamide however it cannot be given when someone has an infection. Giving it could have proved fatal
3. I would have pulsed the patient three times with methylprednisolone and then given 1mg per kg of prednisolone for 6 to 8 weeks after settling the infection
4. I wait for 12 weeks and watch for renal recovery
5. if renal recovery has not happened after 12 weeks of steroid treatment then I would plan for long term hemodialysis
6. renal transplant is also a good option

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
Dr.
Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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Suggest treatment for crescentic glomerulonephritis

Brief Answer: Correct decision has been taken Detailed Answer: Hello Thanks for the query Thank you for giving me a comprehensive history and also attaching the reports. Here are my interpretations 1. They have taken correct clinical decisions based on clinical situation and also lab values 2. Ideally he should have received cyclophosphamide however it cannot be given when someone has an infection. Giving it could have proved fatal 3. I would have pulsed the patient three times with methylprednisolone and then given 1mg per kg of prednisolone for 6 to 8 weeks after settling the infection 4. I wait for 12 weeks and watch for renal recovery 5. if renal recovery has not happened after 12 weeks of steroid treatment then I would plan for long term hemodialysis 6. renal transplant is also a good option I hope I was of help, if you have any further queries please get back to me Regards