Should treatment for rpgn be initiated prior to definitive diagnosis

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Should treatment for rpgn be initiated prior to definitive diagnosis?

Yes. Data obtained in experimental animal models of acute glomerulonephritis/crescentic nephritis show that fibrosis begins within days after disease initiation.

Because patients usually present with evidence of active kidney inflammation and are often azotemic, significant kidney scarring has likely occurred by the time patients receive medical attention.

Starting treatment should be viewed as urgent. Patients can be treated with corticosteroids until kidney biopsy results are available and treatment can be directed by the results (see next question).

While some experts do treat patients based on clinical diagnosis alone, the toxicities and duration of the immunosuppressive therapies used to treat RPGN make a compelling rationale for biopsy confirmation of the diagnosis. Before initiating any immunosuppressive therapies, the treating physician must rule out infection.

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