Renal outcome and risk factors for end‐stage renal disease in pediatric rapidly progressive glomerulonephritis

Background Rapidly progressive glomerulonephritis (RPGN), a clinical diagnosis defined as acute nephritic syndrome with dramatic loss of renal function within few months, is associated with crescentic glomerulonephritis (CresGN), which requires ≥50% crescents in pathology. The percentage of crescents in children with RPGN may vary, however, determining disease characteristics and renal outcome. Methods To evaluate the renal outcomes and factors associated to end-stage renal disease (ESRD), this retrospective cohort study assessed children aged ≤15 years with RPGN at a tertiary medical center. Results Of 67 patients with RPGN, 32 (47.8%) were male; their mean age was 10.6±3.0 years; median follow up was 1.1 years (range 0.02–9.17) and 24 (35.8%) progressed to ESRD. Post-infectious glomerulonephritis was the most frequent cause of RPGN (50.7%). The incidence of ESRD was significantly higher in patients with ≥50% than 3 mg/dl, need for acute dialysis, ≥80% crescents and ≥20% tubular atrophy and interstitial fibrosis (TA/IF) were associated with ESRD. Multivariate analysis showed that need for acute dialysis (hazard ratio [HR] 2.8; 95% confidence interval [CI] 1.1–7.3, p=0.041) and ≥20% TA/IF (HR 4.8; 95% CI 1.4–16.1, p=0.011) were independent risk factors for the development of ESRD. Conclusions Approximately one-third of RPGN in children developed ESRD. Need for acute dialysis and ≥20% TA/IF are the independent risk factors. This article is protected by copyright. All rights reserved.