The glomerular crescent: triggers, evolution, resolution, and implications for therapy

Current Opinion in Nephrology and Hypertension
Lidia AnguianoHans-Joachim Anders

Abstract

Crescents are classical histopathological lesions found in severe forms of rapidly progressive glomerulonephritis, also referred to as crescentic glomerulonephritis (CGN). Crescent formation is a consequence of diverse upstream pathomechanisms and unraveling these mechanisms is of great interest for improving the management of patients affected by CGN. Thus, in this review, we provide an update on the latest insight into the understanding on how crescents develop and how they resolve. Cellular crescents develop from activated parietal epithelial cells (PECs) residing along Bowman's capsule and their formation has as a consequence the decline in glomerular filtration rate (GFR). Cellular crescents can be reversible, but when multilevel growth of PECs associate with an epithelial--mesenchymal transition-like change in cell phenotype, fibrous crescents form, and crescents become irreversible also in terms of GFR recovery. Different molecular pathways trigger the activation of PECs and are a prime therapeutics target in CGN. First, crescent formation requires also vascular injury causing ruptures in the glomerular basement membrane that trigger plasmatic coagulation within Bowman's space. This vascular necrosis can be triggered by ...Continue Reading

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Citations

Mar 8, 2021·BMC Nephrology·Colleen S Curran, Jeffrey B Kopp
Mar 12, 2021·JCI Insight·Marina ZimmermannVictor G Puelles
Jul 28, 2021·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Hernán Trimarchi
Nov 2, 2021·Clinical and Experimental Nephrology·Qing JiaShiren Sun

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Methods Mentioned

BETA
biopsies
confocal microscopy
biopsy

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