Etiology and outcome of rapidly progressive glomerulonephritis in children

Abstract

Introduction: Rapidly progressive glomerulonephritis( RPGN) in children is an uncommon entity. There is paucity of studies on this. It is diagnosed with clinical features of oliguria, hematuria and renal failure in weeks. It is confirmed by finding crescents in renal biopsy. Causes of RPGN in children are different from adults. Objective of study was to identify etiology and outcome of RPGN in children.Material and Methods: It is a retrospective study conducted on 24 pediatric patients, diagnosed with RPGN at the Department of nephrology between January 2009 and December 2018 at our institute. Renal biopsy showed crescentic formations in ≥50%. Based on staining of immune deposits, biopsy was classified as immune-complex GN , pauciimmune GN and anti-glomerular basement membrane GN. Data of patients, clinical features and laboratory parameters was recorded. Factors affecting loss of renal function were identified.Results: There were 24 patients and gender ratio was 7:5 (male: female).Twenty patients had immune complex mediated GN, 3 patients had pauciimmune GN and one patient had anti GBM disease. SLE was the commonest cause of RPGN in this study. At last follow up 11 patients had advance CKD, 20 patients had hypertension and 16 patients had persistent proteinuria.Majority of the patients had fibrous or fibrocellular crescents. Need of dialysis at presentation, oliguria and percentage of fibrous or fibrocellular crescents were predictor of renal function loss.Conclusion: Immune complex GN was the commonest cause of RPGN. Majority of patients had fibrocellular or fibrous crescents. It was due to late referral. Timely intervention could improve outcome of these patients.