Crescentic (rapidly progressive) glomerulonephritis
- Lesion
When glomerular capillaries break, crescents fill Bowman space and kidney function can be lost in weeks.
What it is
Rapidly progressive glomerulonephritis is a clinical syndrome whose biopsy shows crescents in most glomeruli. It is divided by immunofluorescence into three types: antibodies against the basement membrane (linear), immune complexes (granular) and pauci-immune disease, usually ANCA vasculitis, with little or no staining. Early recognition matters because cellular crescents can recover and fibrous ones cannot.
Structure
- Kidneys enlarged and pale with cortical petechiae.
- Crescents compress the tuft; the GBM shows breaks on silver stains and fibrin lies in Bowman space.
- Crescents mature from cellular to fibrocellular to fibrous over weeks.
- Anti-GBM disease shows crescents all at the same stage; ANCA disease often mixes stages.
The three types of crescentic GN
| Type | Immunofluorescence | Serology and setting | Lung involvement |
|---|---|---|---|
| I: anti-GBM | Linear IgG and C3 along the GBM | Anti-GBM antibodies; HLA-DRB1 association; triggers such as smoking or solvents | Alveolar hemorrhage in Goodpasture syndrome |
| II: immune complex | Granular, by cause | Lupus, postinfectious GN, IgA vasculitis; low complement in some | Uncommon |
| III: pauci-immune | Little or none | ANCA: MPO or PR3; small-vessel vasculitis | Capillaritis and nodules (GPA) |
Clinical notes
- Hematuria, falling urine output and rising creatinine over days to weeks; hemoptysis if the lungs are involved.
- Anti-GBM, ANCA, complement and ANA tests are sent together because the treatment is urgent and similar.
Test yourself
Think of the answer, then tap the question to see it.
Which immunofluorescence pattern defines anti-GBM disease?
Smooth linear deposition of IgG along the glomerular basement membrane.
Pauci-immune crescentic GN is usually associated with what?
ANCA-associated small-vessel vasculitis: microscopic polyangiitis (MPO-ANCA) or granulomatosis with polyangiitis (PR3-ANCA).
Why does the age of the crescents matter?
Cellular crescents can resolve with treatment; fibrous crescents mean permanent loss of the glomerulus.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Anti-glomerular basement membrane disease: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Glomerulonephritis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.