Rapidly progressive glomerulonephritis (RPGN) is characterized by the rapid formation of "crescents" outside the glomerular capillaries that leads to acute kidney failure within weeks or months. It is categorized based on etiology into 3 groups - RPGN associated with systemic diseases, post-infectious RPGN caused by immune complexes, and pauci-immune RPGN. The post-infectious type is identified by crescents forming adhesions between the glomerular tuft and Bowman's capsule, with glomerular hypercellularity and leukocyte infiltration. Prognosis for RPGN is generally poor, though post-infectious cases have a

1. The KIDNEY - RPGN
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. Rapidly Progressive Glomerulonephritis
(Synonyms: RPGN, Crescentic GN,
Extracapillary GN)

3. RPGN
• RPGN presents with an acute reduction in renal function resulting in
acute renal failure in a few weeks or months.
• It is characterised by formation of ‘crescents’ (crescentic GN) outside the
glomerular capillaries (extracapillary GN)
• RPGN occurs most frequently in adults
• slight male preponderance.
• Prognosis of RPGN in general is dismal.

4. RPGN - ETIOPATHOGENESIS
• A number of primary glomerular and systemic diseases are characterised
by formation of crescents.
• Based on the etiologic agents and pathogenetic mechanism, patients
with RPGN are divided into 3 groups (Table):
• 1. RPGN in systemic diseases (anti-GBM type)
• 2. Post-infectious RPGN (immune-complex type)
• 3. Pauci-immune RPGN.
• Following three serologic markers are used for categorising RPGN:
• i) serum C3 level,
• ii) anti-GBM antibody; and
• iii) anti-neutrophil cytoplasmic antibody (ANCA)

5. Distinguishing features of 3 main
categories of RPGN

7. RPGN (post-infectious type),
Light microscopic appearance.
There are crescents in Bowman’s space forming adhesions between
the glomerular tuft and Bowman’s capsule.
The tuft shows hypercellularity & leucocytic infiltration.

8. RPGN
diagrammatic representation of ultrastructure of a portion of glomerular
lobule showing epithelial crescent formation & subepithelial granular
deposits.

9. RPGN CLINICAL FEATURES
• Generally, the features of postinfectious RPGN are similar to those of
acute GN, presenting as acute renal failure.
• The patients of Goodpasture’s syndrome may present as acute renal
failure and/or associated intrapulmonary haemorrhage
producing recurrent haemoptysis.
• Prognosis of all forms of RPGN is poor.
• However, post-infectious cases have somewhat better outcome and
may show recovery.