title: Spectrum of glomerular diseases causing acute kidney injury; 25 years experience from a single center.
abstract: BACKGROUND
  Acute kidney injury (AKI) is common in nephro-urological practice. Its incidence, prevalence and etiology vary widely, mainly due to variations in the definitions of AKI.
  
  
  OBJECTIVE
  We aim to report the spectrum of glomerular diseases presenting as AKI at a kidney referral center in Pakistan.
  
  
  METHODS
  An observational cohort of patients identified as having AKI which was defined according to RIFLE criteria, with normal size, non-obstructed kidneys on ultrasonography, along with active urine sediment, edema and new onset hypertension.
  
  
  RESULTS
  From 1990 to 2014, 236 cases of AKI secondary to acute glomerulonephritis (AGN) registered at this institution. Mean age of patients was 27.94± 12.79 years and M:F ratio was 0.77:1. Thirty percent patients revealed crescents on renal biopsy. AGN without crescents was seen in 33.05% of cases. Postinfectious GN was found in 14.4%, lupus nephritis in 8.5% and mesangiocapillary GN in 3.4% cases. Renal replacement therapy (RRT) required in 75.84% patients. Pulse steroids were given in 45.33% cases followed by oral steroids. Pulse cyclophoshphamide was given in 23.7% cases and plasmapheresis was used in 3.38% cases. Complete recovery was seen in 44%, while 11.44% died during acute phase of illness. About 19.49 % developed chronic kidney disease (CKD) and 25.84% were lost to long- term follow-up.
  
  
  CONCLUSIONS
  Although glomerular diseases contribute only 4.19 % of total AKI at this center, morbidity associated with illness and its treatment is more marked than other AKI groups. Another notable factor is late referral of these patients to specialized centers resulting in undesirable outcome.
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Rubina
authors.initials: R
authors.lastname: Naqvi
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Mubarak
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Ejaz
authors.initials: E
authors.lastname: Ahmed
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Fazal
authors.initials: F
authors.lastname: Akhtar
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Sajid
authors.initials: S
authors.lastname: Bhatti
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Anwar
authors.initials: A
authors.lastname: Naqvi
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Adib
authors.initials: A
authors.lastname: Rizvi
keywords: Acute glomerulonephritis; Acute kidney injury; Crescentic glomerulonephritis; Plasmapheresis; Renal biopsy