Management of Crescentic Glomerulonephritis: What Are the Recent Advances?

Crescentic glomerulonephritis (GN) is a life-threatening clinical syndrome characterized by crescents which are morphological manifestations of severe glomerular injury. Immunologically, crescentic GN are classified as anti-glomerular basement membrane nephritis, immune complex-mediated GN and pauci-immune GN. Conventional treatment for crescentic GN mainly consists of corticosteroids, immunosuppressants and plasma exchange. Plasmapheresis is beneficial for patients with Goodpasture's syndrome and those with severe pauci-immune GN. Recently, new therapeutic agents have emerged, such as monoclonal antibodies to T cells, B cells and cytokines (e.g. anti-CD20 antibodies and TNF-alpha inhibitors) and signal transduction inhibitors, which may provide satisfactory alternatives. However, most of these treatments have only been established in experimental crescentic GN, described in single cases or reported in open-label trials; thus, the safety and efficacy of these agents remain to be investigated via controlled clinical trials. Copyright (C) 2013 S. Karger AG, Basel