What are the disease progression patterns of chronic glomerulonephritis?

Updated: Feb 24, 2020
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The progression from acute glomerulonephritis to chronic glomerulonephritis is variable, depending to a considerable extent on the cause of the condition. Whereas complete recovery of renal function is the rule for patients with poststreptococcal glomerulonephritis, several other glomerulonephritides, such as immunoglobulin A (IgA) nephropathy, often have a relatively benign course, and many do not progress to ESRD. Progression patterns may be summarized as follows:

  • Rapidly progressive glomerulonephritis or crescentic glomerulonephritis – About 90% of patients progress to ESRD within weeks or months.

  • Focal segmental glomerulosclerosis – About 80% of patients progress to ESRD in 10 years; patients with the collapsing variant (malignant focal segmental glomerulosclerosis) have a more rapid progression; this form may be idiopathic or related to HIV infection

  • Membranous nephropathy – About 20-30% of patients with membranous nephropathy progress to chronic renal failure (CRF) and ESRD in 10 years

  • Membranoproliferative glomerulonephritis – About 40% of patients with membranoproliferative glomerulonephritis progress to CRF and ESRD in 10 years [2]

  • IgA nephropathy – About 10% of patients with IgA nephropathy progress to CRF and ESRD in 10 years [3, 4]

  • Poststreptococcal glomerulonephritis – About 1-2% of patients with poststreptococcal glomerulonephritis progress to CRF and ESRD; older children who present with crescentic glomerulonephritis are at greatest risk

  • Lupus nephritis – Overall, about 20% of patients with lupus nephritis progress to CRF and ESRD in 10 years; however, patients with certain histologic variants (eg, class IV) may have a more rapid decline. [5] The presence of antineutrophil cytoplasmic antibody (ANCA) is also  an independent risk factor for poor renal outcomes. [6]

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